On January 20, 2023, the Biden administration announced that it would end public health emergency (and national emergency) declarations effective May 11, 2023.
what’s changing: Nothing. The availability, access and cost of COVID-19 vaccines, including boosters, is determined by the supply of federally procured vaccines, not a public health emergency.
what is that: As long as federally purchased vaccines last, COVID-19 vaccines will be free to everyone, regardless of insurance coverage. Providers of federally purchased vaccines are not allowed to charge patients or deny vaccines based on the recipient’s coverage or network status.
Although a federal rule requires private insurers to temporarily reimburse out-of-network providers for vaccine administration during a public health emergency, vaccine access will be unaffected by insurers who end these payments when until the federal supply remains, as vaccine providers are not allowed to. Should deny anyone federally purchased vaccine based on recipient’s coverage or network status and not charge any out-of-pocket costs.
Because of the Affordable Care Act and other recent legislation, vaccines will remain free for most people with private and public insurance, even after the federal supply of vaccines runs out. However, the cost can become a barrier for uninsured and underinsured adults when federally purchased supplements run out, and privately insured people may need to confirm their provider is in-network. To learn more about what happens after the federal supply of vaccines runs out, see our overview on the commercialization of COVID vaccines and the expected increase in COVID vaccine prices.
Importantly, the Food and Drug Administration’s (FDA) emergency use authorizations for COVID-19 vaccines (and treatments and tests) will remain in effect because they are tied to a separate emergency declaration, not the public health emergency that expires in May. Is. ,
COVID test at home
what’s changingAt-home (or over-the-counter) testing may be more expensive for people with insurance. After May 11, 2023, people with traditional Medicare will no longer receive the free, at-home tests. People with private insurance and Medicare Advantage (private Medicare plans) will no longer be guaranteed free at-home tests, but some insurers may voluntarily continue to cover them.
For those on Medicaid, at-home tests will be covered at no cost until September 2024. After that date, at-home testing coverage will vary by state.
A temporary Medicaid coverage option adopted by 15 states has given uninsured people access to COVID-19 testing services, including at-home testing without cost-sharing, but the program will end with a public health emergency.
what is that: Uninsured people in most states were already paying full price for at-home testing because they were not eligible for temporary Medicaid coverage for COVID testing services. The uninsured and others who can’t afford at-home tests can still find them at a free clinic, community health center, public health department, library, or other local organization. Additionally, some tests are provided by mail through the federal government, although supplies are dwindling.
PCR and rapid tests ordered or administered by a healthcare professional
what’s changingAlthough most insured people will still have coverage for COVID tests ordered or administered by a health professional, these tests may no longer be free.
- For those with traditional Medicare, there will be no cost for the test, but there may be cost-sharing for the visit to the concerned doctor.
- For people with Medicare Advantage and private insurance, both the test and the associated doctor’s visit may be subject to cost-sharing, depending on the plan. Additionally, some insurers may begin limiting the number of tests covered or may require tests to be performed by in-network providers. People in grandfathered or non-ACA-compliant plans will have no guarantee of coverage for the tests and may have to pay full cost.
- For those with Medicaid, the free tests will continue until September 2024, after which states may limit the number of covered tests or implement modest cost-sharing.
- Uninsured people in the 15 states that adopted the temporary Medicaid coverage option will not be able to receive COVID-19 testing services, including at-home testing, without cost-sharing because the program ends with a public health emergency.
what is that: Uninsured people in most states were not eligible for a temporary Medicaid route for COVID testing and so will continue to pay full cost for tests until they can get tested through a free clinic or community health center.
what’s changing: People with public coverage may face new cost-sharing for pharmaceutical COVID treatments (unless those doses are purchased by the federal government, as discussed below). Medicare beneficiaries may face cost-sharing requirements for some COVID pharmaceutical treatments after May 11. Medicaid and the CHIP programs will continue to cover all pharmaceutical treatments with no-cost sharing through September 2024. After that date, these treatments will continue to be covered; However, states may impose usage limits and nominal cost-sharing.
what is that: Any pharmaceutical treatment dose (such as Paxlovid) purchased by the federal government is still free to everyone, regardless of insurance coverage. It is based on the availability of federal supplies and is not affected by the end of a public health emergency.
Most insured people already faced cost-sharing for hospitalizations and outpatient visits related to COVID treatment. Private insurers were not required to waive cost-sharing for any COVID treatment. Although some did so voluntarily, most insurers had phased out these exemptions a year earlier.
what’s changingDuring a public health emergency, some of the flexibility associated with providing health care through telehealth would be lost.
- During the public health emergency, providers writing controlled substance prescriptions were allowed to do so via telemedicine, but after May 11, in-person visits would be required.
- Due to the pandemic, all states and DC temporarily waived some aspects of state licensure requirements so that providers with equivalent licenses in other states can practice remotely via telehealth. Some states tied those policies to the end of a federal public health emergency so that those policies would expire unless those states changed their policy.
- The Department of Health and Human Services temporarily waived fines against providers using technologies that do not comply with federal privacy and security regulations in the provision of telehealth services during a public health emergency. Enforcement of these rules when the public health emergency ends will limit the provision of telehealth to so-called “HIPAA-compliant” technologies and communications offerings.
what is that: Expanded telehealth for Medicare beneficiaries was once a public health emergency, but due to recent legislation, will remain unchanged until December 31, 2024. Most private insurers already covered telemedicine before the pandemic. In Medicaid, states have broad authority to cover telehealth without federal approval. Most states have made or plan to make some Medicaid telehealth flexibility permanent.
Overall, the broadest impact from the end of the public health emergency will likely be higher costs for COVID tests – both at-home tests and tests performed by physicians. As many Americans delay or go without needed care because of cost, the end of free COVID tests could have wide-ranging implications for people’s ability to get a timely COVID diagnosis or prevent transmission. Other changes in health policies that are associated with public health emergencies, national emergencies and other declarations are discussed in more detail in our previous overviews.
Also, and potentially more important, changes will come when federal supplies of vaccines, treatments and tests run out, although the timing of that has not yet been determined and is not linked to a public health emergency. The Biden administration has announced that it has no more money for vaccines, tests or treatments, and Congress will need to provide more money.
Importantly, continued enrollment for Medicaid enrollees – which has led to record-high enrollment in Medicaid – was once tied to the end of a public health emergency. However, recent legislation removed this provision from the public health emergency and ended continuous enrollment on March 31, 2023. States can begin disenrolling people from Medicaid as early as April 1, 2023, although most states will take a year to complete these enrollments. KFF estimates that millions of people will lose Medicaid coverage during this unwinding period.