The case of Thomas Eric Duncan — the man who died of Ebola in Dallas today — has raised questions about how U.S. commercial health insurance plans and other benefits plans might cover Ebola care expenses.
The answers could also shed light on how carriers might cover care for the other serious infectious diseases now on epidemiologists’ radar screens, such as Middle East Respiratory Syndrome (MERS) and several severe strains of influenza.
Analysts at Lockton recently estimated that hospital care for a typical U.S. patient with Ebola might cost more than $100,000 per case.
The analysts estimated that a typical patient with Ebola would need two weeks of supportive therapy in a hospital intensive care unit (ICU), at an average cost of about $6,000 per day.
In addition to needing an ICU care, a patient with Ebola might need:
- Special isolation equipment and decontamination procedures.
- Extra, well-protected medical personnel required.
- Treatment for complications such as shock and internal bleeding.
The complications could lead to a need for expensive products and services, such as platelet therapy and factor replacement, the analysts say.
“Conservatively, this could add several thousands of dollars of cost per day for several days or possibly longer,” the analysts say.
U.S. doctors successfully treated one patient with ZMapp, a drug that has not yet been approved for sale in the United States and has not yet been priced. Drug companies could provide some Ebola drugs for free or at a reduced cost, or the federal government could help pay for the drugs, to help prevent a public health emergency.
Health insurers use to protect themselves against the threat of catastrophic disease outbreaks. Aetna (NYSE:AET), for example, has protected itself against catastrophic losses by working with Vitality Re Ltd., a special-purpose vehicle in the Cayman Islands that funded reinsurance arrangements by selling health-linked notes to investors.
Employers with self-insured plans often use stop-loss insurance — insurance that protects self-insured plans against catastrophic losses.
Insurance policies, self-insured plans, reinsurers and stop-loss providers often exclude coverage for experimental treatments.
In the case of Ebola, insurers and self-insured plans might decide to pay for experimental treatments, but, in that case, the plan managers could find that the reinsurers or stop-loss providers will still want to enforce the experimental treatment exclusions in the reinsurance or stop-loss contracts, the Lockton analysts say.
Kaiser reported that the typical self-insured plan with 1 to 199 employees has an attachment point, or stop-loss deductible, of about $134,000. For larger employers, the average attachment point is about $328,000. For 2014, for individual qualified health plans (QHPs) covered by the Patient Protection and Affordable Care Act (PPACA) reinsurance program, the attachment point is just $45,000.