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Will the unvaccinated in NY actually suffer higher insurance premiums?

While half of America views the government's attempts to persuade them into getting the COVD-19 vaccine as unnecessary bribing and an infringement of their freedoms, others consider the vaccine drives and other efforts as a necessary part of achieving herd immunity. The debate over the vaccine has resulted in unrest and pitted people against each other. Businesses, schools, and retailers in New York and other major hubs are conflicted about whether they should mandate proof of vaccination or routine COVID testing for customers, students, and employees.

Regardless of where you stand on the subject, there may be monetary costs to refusing the vaccination.

In America, the average cost of hospitalization due to COVID-19 is around $20,000. Even with insurance, patients would need to pay about $1,300 in out-of-pocket expenses. Back when the coronavirus was still novel, several insurers had voluntarily waived the out-of-pocket costs for COVID-19 treatment to reduce patient medical expenses, including free COVID-tests, lower copays, and deductibles. At least 88% of people enrolled in an individual or fully insured plan had their out-of-pocket costs waived at one point during the pandemic.

Now that COVID tests are being requested more for monitoring purposes than medical need, insurers are beginning to treat the virus much like any other illness - they are no longer shouldering the full cost of treatment. For example, Aetna ended its waiver policy on February 28, 2021, and UnitedHealthCare followed suit a month later (although their policies periodically change due to the constant emergence of new variants and protocols).

Insurers are struggling with whether insurance costs relating to COVID treatment should be shared by everyone or solely by unvaccinated individuals. Insurance companies cite, among other factors, that a high percentage of hospitalized patients are unvaccinated. The wide-scale accessibility and availability of the COVID vaccine mean the majority view vaccination as a preventive measure against the virus.

Although the vaccine can't prevent contracting the virus, the CDC has prescribed it as a surefire way to reduce symptoms and avoid hospitalization. Thus, insurers are leaning towards considering unvaccinated folk as engaging in risky behavior, much like scuba diving or smoking. The Affordable Care Act (ACA) already allows insurance companies to charge an extra 50% on the premiums of smokers versus nonsmokers - the logic being that smokers willfully harm their health, put others at risk, and financially hurt the rest of society. Similarly, advocates for the COVID vaccine argue that people who choose to remain unvaccinated not only expose others to the risk of getting the virus but increase everybody's health insurance premium prices in the next year.

Since the FDA hasn't fully approved the various vaccines and booster shots (apart from Pfizer's), insurers cannot impose fines or surcharges on those who choose not to get vaccinated - yet. But as we're already in the second year of this so-called epidemic, the insurance environment is bound to keep changing.

For more information on health insurance in New York, visit NY Small Health.

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