Health Care Expenditures and Cost-Sharing Before and After Long COVID: Three-Year Evidence From a Statewide Multi-Payer Cohort

The objective of this study was to quantify expenditures for long COVID (LC) before/after diagnosis and compare 3-year trajectories with similar patients without LC in claims. A retrospective cohort study was conducted using Colorado All Payer Claims Database multi-payer claims (October 1, 2020–August 1, 2024). Adults with ≥1 U09.9 code and 1-year continuous enrollment pre-index were followed 1 year pre- and 2 years post-index. Multipart models addressed right-censoring; clustered bootstraps produced confidence intervals overall and by age, sex, and payer. Sample: 25,229 LC and 126,089 comparison patients across commercial, Medicare, Medicaid, and dual coverage. LC patients averaged $79,777 total expenditures over 3 years and $5,158 in cost-sharing. Spending rose about 6 months before the index date, peaked just before the index date, and returned to baseline within 6 months; excess spending totaled $21,597 per patient. Dual-eligible patients had the highest absolute expenditures but lowest relative increase, whereas Medicaid had the lowest absolute expenditures and highest relative increase. LC patients had a substantial financial burden concentrated around diagnosis, highlighting broader, system-level implications for health care spending.