Your guide to Medicare, Medicaid and private insurance coverage after the end of the COVID-19 Public Health Emergen

The pandemic has had a profound impact on the lives of people across the globe. However, the COVID-19 Public Health Emergency declaration in the United States provided COVID-19 tests, treatments, and vaccines freely to everyone, regardless of their insurance status, reducing healthcare expenses significantly.

As the COVID-19 Public health emergency comes to an end, access to these services will depend on insurance coverage through Medicare, Medicaid, or private companies.

If you're a

Medicare

beneficiary, you probably want to know how this change will impact your coverage and benefits.

Let's discuss when the COVID-19 Public Health Emergency will end and how it may impact you.

What Is the COVID-19 Public Health Emergency?

In the United States, the COVID-19 Public Health Emergency (PHE) was declared on January 30, 2020, in response to the COVID-19 pandemic.

The PHE allowed the government to activate emergency response plans, allocate resources, and implement policies to control the spread of the virus and protect public health. It also led to measures such as vaccine authorization, mask mandates, and financial assistance to healthcare providers and affected individuals. 

When Does the COVID-19 Public Health Emergency End?

The Biden Administration has announced that the public health emergency (and national emergency) declarations made on January 30, 2020, will end as of May 11, 2023**.**

This deadline has been extended in the past, however. But if there isn't a sharp increase in COVID-19 cases, this end date will likely be upheld.

How Will The End of the COVID-19 Public Health Emergency Affect Medicare?

The PHE has allowed the government to waive or modify certain healthcare programs, which has helped healthcare providers and beneficiaries cope with the pandemic's impact. But it's necessary to examine how the end of the PHE may affect these programs.

Let's discuss the various changes in detail.

1. COVID-19 Vaccines

As long as the supply of COVID-19 vaccines purchased by the federal government lasts, they will be available to all individuals free of charge, regardless of their insurance coverage.

Providers who administer federally purchased vaccines are prohibited from charging patients or denying vaccination based on the patient's insurance coverage or network status.

However, if the federal supply of vaccines runs out, it may or may not affect you based on your healthcare policy.

Let's look into the different scenarios:

If you're on

Medicare

:

You'll still get vaccines for free under the

Affordable Care Act

. Medicare Part B will cover the cost of the vaccine.

If you're on Medicaid:

You'll continue to receive free vaccines even if the federal supply of vaccines runs out.

If you have private insurance:

COVID-19 vaccines will be free only if you get them from an in-network healthcare provider. However, if you receive the vaccine from a healthcare provider outside your network, you may need to pay for the out-of-pocket expenses.

If you're uninsured or underinsured:

You may incur out-of-pocket costs as the vaccines might not be freely available once the PHE ends.

2. At-Home COVID-19 Tests

Currently, Medicare covers up to 8 over-the-counter COVID tests per month. However, this will change with the end of the PHE in the following ways:

If you're on Original Medicare:

You'll no longer receive a free

at-home COVID test kit

. You may incur some out-of-pocket expenses if you choose to purchase these kits.

If you're on Medicaid:

You'll continue to get at-home tests for free until September 2024, but once this deadline passes, coverage for these tests could vary depending on your state of residence.

If you have private insurance or the

Medicare Advantage Plan

:

Private insurers and Medicare Advantage Plans don't guarantee free at-home tests, although some providers may still cover them. It's best to check with your provider for information about this.

If you're uninsured or underinsured:

If your state was one of the 15 states (e.g., CA, CO, CT, IA, IL, LA, ME, MN, NC, NH, NM, NV, SC, UT, WV) that provided Medicaid coverage for at-home tests to uninsured individuals, this coverage will end when the public health emergency ends. This means you'll no longer get coverage for COVID-19 at-home tests.

If you can't afford at-home tests, you may be able to get them for free at a community health center, public health department, library, free clinic, or other local organizations. The federal government also provides some tests by mail, but there's a limited supply.

3. PCR and Rapid tests by Healthcare Professional

When the PHE ends, PCR or rapid tests ordered or administered by a healthcare professional may still be covered but will no longer be completely free.

The coverage will vary depending on your healthcare plan:

If you're on Original Medicare:

PCR and rapid tests will be free, but you may be responsible for out-of-pocket expenses related to your doctor's visit.

If you're on Medicaid:

You can get PCR or rapid tests for free until September 2024. After this date, states could restrict the number of tests covered or require a small amount of cost-sharing.

If you have private insurance or a Medicare Advantage Plan

Depending on your specific plan, you may have to share the cost of both the test and the related doctor's visit. Some providers may limit the number of tests covered and provide only in-network coverage.

Additionally, if you're enrolled in non-ACA-compliant or grandfathered plans, you might not get guaranteed test coverage and may have to pay the full amount.

If you're uninsured or underinsured:

If your state is one of the 15 states that provides Medicaid coverage for COVID-tests to uninsured individuals, this coverage will end with the public health emergency. This means you'll need to pay for COVID-19 testing services after May 11, 2023.

If you cannot afford COVID-19 testing services, you may be able to get them for free at a community health center, public health department, library, free clinic, or other local organizations.

4. COVID Treatments

All COVID-19 pharmaceutical treatment doses (e.g., oral antivirals like Paxlovid and Lagevrio) purchased by the federal government are free, regardless of your insurance coverage. 

However, coverage for COVID-19 treatments not purchased by the federal government varies depending on your healthcare plan.

If you're on Medicare:

You may have to share the cost of certain pharmaceutical COVID treatments when the PHE ends.

If you're on Medicaid:

Medicaid will continue to cover the entire cost of the pharmaceutical COVID treatments until September 2024. After this date, states will continue to cover the expenses but could limit its use or require a small amount of cost-sharing.

If you have private insurance:

Your out-of-pocket costs may vary depending on your plan. Most people with private insurance already had to bear some of the costs for hospitalizations and outpatient visits related to COVID.

While a few companies initially decided to waive out-of-pocket costs for COVID-19 treatment, they discontinued this practice in 2022. If you have a private insurance plan, you'll probably be responsible for paying deductibles and other cost-sharing fees as outlined in your policy.

If you're uninsured or underinsured:

With the end of the PHE, you'll probably have increased out-of-pocket expenses for certain COVID treatments. You may be able to rely on safety-net providers to cover these extra expenses.

5. TeleHealth

Some Telemedicine flexibility will change after May 11, 2023, including:

Other changes to telemedicine depend on your plan:

Medicare beneficiaries:

Telehealth services for Medicare beneficiaries, which were previously linked to the public health emergency, will continue without any alterations until December 31, 2024.

Medicaid beneficiaries:

Most states have made, or intend to make, certain Medicaid telehealth flexibilities permanent.

Private insurance:

Telemedicine coverage by most private insurance may not be impacted by the end of the Public Health Emergency as it covered telemedicine before the PHE was declared.

Nevertheless, if your plan has coverage, telehealth and other remote care services may still be subject to cost-sharing, prior authorization, or other forms of medical management.

6. Prescription Refill

During the COVID-19 Public Health Emergency, Medicare Part D enrollees could receive up to a 90-day (3-month) supply of covered Part D drugs in one fill or refill upon request. This flexibility, however, will no longer be available once the PHE concludes.

Consequently, enrollees in Medicare Part D plans, including stand-alone and Medicare Advantage drug plans, may face prescription refill restrictions, as healthcare providers may limit the supply quantity.

7. Hospital Care

The end of the COVID-19 Public Health Emergency can bring a few changes in Medicare costs associated with your hospital care, such as:

8. Medicaid Enrollments

During the pandemic, the federal government increased Medicaid funding to states that agreed not to remove anyone from their Medicaid program during the public health emergency.

However, as of March 31, 2023, this requirement for continuous enrollment will end. The temporary funding increase will gradually decrease from April 1, 2023, until ending on December 31, 2023.

As a result, states may remove Medicaid enrollees who do not meet eligibility requirements.

Keep Yourself Informed and Up-to-Date

As the COVID-19 Public Health Emergency ends, you'll want to stay informed and up-to-date on healthcare coverage and benefits changes. Although the declaration allowed for free access to COVID-19 services, the shift back may significantly impact the uninsured or underinsured.

Navigating changes to your Medicare coverage after the COVID-19 PHE ends can be complex, even overwhelming. If you have any questions on how these changes may impact your coverage after May 11, 2023, call us at 1-888-376-2028.

Our advisors

know the ins and outs of each healthcare plan and can help you make informed decisions about your healthcare needs.