COVID-19 adds more than medical bills for U.S. families
A new cross-sectional survey study draws a sharper line between the direct charges attached to COVID-19 care and the broader burden families carried after infection. In a national nonprobability sample of U.S. adults surveyed in fall 2023, out-of-pocket medical expenses were often small on paper, yet the time spent obtaining care and the strain of non-medical expenses remained meaningful. The findings matter because claims data usually capture only the medical side of the ledger, leaving travel, waiting, childcare, lost hours, and household disruption outside the frame.
Two surveys made up the study design: one focused on personal burden in adults and the other on caregiver burden in children. After quality-based exclusions, investigators analyzed 409 adult responses and 52 child responses. More than 87% of respondents were insured, so these estimates do not reflect an uninsured population alone. Even in a largely insured sample, the illness carried costs that went beyond the clinic or hospital bill.
Median out-of-pocket medical costs per visit stayed relatively low across settings. In the adult sample, the median was $5 for emergency department visits and $10 for urgent care. In the child sample, the median ranged from $0 for emergency department care to $75 for hospitalization. Non-medical costs were also modest at the median level, generally $28 or less across care settings. Those numbers could look reassuring in isolation. They are not the whole story.
Time spent caring for COVID-19 was often the larger burden
Time consumption was substantial across both groups. Median time spent receiving care ranged from 90 minutes for primary care in the child sample to 300 minutes for emergency department care in the adult sample. That span includes the hours absorbed by travel and waiting, not just the encounter itself. For families balancing work, school, caregiving, and transportation, those hours can become the most expensive part of the episode even when the receipt at the end looks manageable.
The survey results also captured financial hardship directly, and here the gap between low median costs and lived burden becomes clear. COVID-related financial challenges were reported by 34% of adults and 29% of caregivers in the child sample. The most common difficulty was paying non-medical bills, affecting 11% of adults and 15% of caregivers. Problems paying COVID-19-related medical bills were reported by 12% in both groups. Those proportions show that direct spending was not concentrated in a narrow group of families with extreme bills alone; a sizable minority ran into difficulty even when median out-of-pocket expenses remained modest.
The study’s structure helps explain why these findings are easy to miss in routine health economics. Administrative datasets usually track billed services and payer payments, but they do not reliably capture gasoline, parking, meals, lost time, or the logistical drag of seeking care. A family who spends an afternoon in an emergency department may leave with a modest medical bill and still absorb hours of unpaid labor, transport expenses, and disrupted schedules. For a respiratory infection that can affect multiple household members, those hidden costs are not peripheral. They are part of the clinical and economic burden.
The adult and pediatric findings also point to different patterns of burden by care setting. Emergency department care carried the highest time burden in adults, while hospitalization in children reached the highest reported median medical cost among the child settings. Primary care visits in the child sample had the shortest median time burden, but even that still represented an hour and a half. In practical terms, the setting of care shapes not only cost but also the degree to which the episode interrupts daily life.
Why these estimates matter for prevention and treatment decisions
This preprint is especially relevant for economic evaluations of vaccines, antivirals, and other COVID-19 interventions because it expands the unit of analysis beyond claims-based spending. Cost-effectiveness models that omit non-medical spending and time burden can underestimate the real benefit of preventing illness. A modest copay does not equal a modest burden when the household absorbs several hours of lost time and additional out-of-pocket costs outside the medical chart.
The study also provides a reminder that insured status does not eliminate financial strain. With over 87% of respondents insured, the reported burden cannot be dismissed as the product of an entirely uncovered population. Instead, it suggests that even families with coverage can face meaningful disruption when illness requires urgent evaluation, prolonged observation, or hospitalization. In pediatric households, caregivers may absorb the downstream consequences directly through missed work, transportation costs, and bills that arrive after the acute infection has passed.
Because this is a preprint, the findings should be interpreted with appropriate caution. The survey relied on nonprobability samples, and the child sample was small. Recall bias and selection bias are possible, and the results may not generalize cleanly to all U.S. households. Still, the direction of the signal is hard to ignore: the direct bills were often limited, but the broader burden of illness was not.
The most useful contribution of the study may be conceptual rather than merely numeric. It shows that the economics of COVID-19 illness cannot be reduced to copays and hospital invoices. For patients, caregivers, and policymakers, the hidden costs of travel, waiting, and household disruption belong in the same conversation as the medical encounter itself. Future estimates of the value of prevention will be incomplete unless they count those hours and those bills alongside clinical utilization.