While the country works to protect itself from COVID-19, some Americans are dealing with both the medical and financial impacts of the virus as health insurance open enrollment soon begins for many.
Outside Pittsburgh, Courtney Kohler's day-to-day life took a sharp turn in December 2020 after a battle with COVID-19 that landed her in the hospital.
"It was literally in the blink of an eye," Kohler said.
She says she learned she was in renal failure, and now with her kidneys not working right, anticipates needing a new one.
"It's been devastating. I went from pretty active, you know, I have two kids. I worked full time. We went to camp, we went kayaking. And now I sleep and go to dialysis and that's about it," she said.
While she wades through all the medical information of her new reality, she's also sorting through the bills that come with it.
We sat down with her as she showed us her medications and piles of paper.
"This is my daily cocktail of meds," Kohler said.
She estimates she's paid about $3,000 out of pocket. While she says health insurance and disability help cover most bills, looking ahead she expects the charges will keep coming. That changes how she and her family plan financially.
"I'm not working now so I'm not putting anything towards my retirement anymore. What little we did have started is gone, so now I'm thinking, well, retirement would have been 65 maybe — now it's 75 if I'm lucky," Kohler said. "We have college to pay for. Will that get done? Because everything's being pushed back now because I'm not even able to pay into that because anything that would have gone into it is going to have to go towards this now."
Recent cost estimates from FAIR Health find the average estimated allowed amount, what's paid to an in-network provider including from a plan and patient for COVID-19 hospitalization, is more than $30,000 and nearly $100,000 for a COVID-19 hospitalization with complexities.
"Early on in the pandemic a lot of insurance companies were waiving those costs, so if you got hospitalized or you needed treatment you would have zero cost-sharing. Well those days are over for the most part," said Sabrina Corlette.
Corlette is a research professor with the Center on Health Insurance Reforms at Georgetown University.
"Even as COVID costs go up, other costs are going down. So, so far anyway we've seen premiums stay relatively stable. That could change, however, over time," said Corlette.
An analysis of initial rate filings for some marketplace insurers by the Peterson-KFF Health System Tracker suggests the pandemic will not drive health spending next year.
"The exchange plans have subsidies based on the benchmark plan in that person's area and for that age group. And so based on the early rate filings that we're seeing, average premiums are decreasing because of the spending and utilization that hasn't quite rebounded. Because of this, people's subsidies may change, so lower premiums means lower financial assistance. So people may have to change their plan to get the same level of financial assistance or keep paying however much they were before," said Krutika Amin, an associate director for the Program on the ACA at the Kaiser Family Foundation.
A spokesperson for AHIP, a health insurance trade association, said the only markets where an individual may see higher premiums is in underwritten markets.
David Allen, an AHIP spokesperson, stated:
"Every American deserves affordable coverage and high-quality care. That's why AHIP supports elements of the Affordable Care Act and other rules which protect unvaccinated individuals from being charged higher premiums. This is true for the plans the vast majority of Americans have, including Medicare and Medicaid.
"The only markets where individuals could see higher premiums is in underwritten markets like short-term limited duration; however it is important to remember that short-term limited duration insurance products are not designed to be comprehensive long-term coverage."
Financial strain from medical issues isn't new with COVID, though.
"You just never know when you're going to be in one of these situations," said Davey Shepherd, the executive director of The Joe Beretta Foundation.
The organization works with heart failure patients and their families in the Nashville and Pittsburgh areas with some non-medical expenses while patients receive treatments.
"Our patients kind of felt the same thing that everybody else felt during COVID. If you lost work hours, if you lost time, if you lost the ability to travel back and forth to see family, that isolation that kind of the whole country went through, imagine going through that while you're also in medical crisis," said Shepherd.
Some, Shepherd said, dealt with delayed procedures over the course of the pandemic, too.
"With us taking care of practical out-of-pocket expenses, for us the bigger thing almost is lack of work and regular bills piling up. When you get behind on rent, you get behind on a car payment, those are the kinds of things that affect your day-to-day life and your ability to go out and win bread for your family. And that's not medical related. That's just the reality of life," said Shepherd. "So what we saw from COVID-19 was an increase in those types of situations for families because they were unable to get treatment as soon as they would have liked to be able to."
The foundation partners with places like Family House in Pittsburgh, which house families undergoing medical treatment at lower rates.
"So over the last fiscal year over our nights of service, 41% of them received some form of additional financial assistance beyond our charitable room rate," said Caily Grube, director of development for Family House.
Grube said compared to the organization's last pre-COVID year, the money spent on family assistance increased 37%.
"That shows the need families are expressing to us for the new economic realities they're facing," said Grube.
For Courtney Kohler: "I'm thankful to have insurance; it's great. I'm thankful to be here paying hospital bills in that my family's not paying a funeral bill," she said.
She offers this to others: "Just do the right thing and please get vaccinated, wear a mask, you know, do your part to save people, save your children."