What the end of the COVID public health emergency really means

In May 2023, the Biden administration will end the national and public health emergency status of the COVID pandemic, which were declared three years ago. The move revamps the federal response to the pandemic in ways that could limit Americans’ access to life-saving treatments, tests and other health care related to COVID.

Most people will continue to have free access to COVID vaccines, including boosters, even after the public health emergency ends.

However, you may have to pay for all or part of your COVID tests and treatments depending on whether you are insured and the type of coverage you have.

Even with some protections in place, you may still have trouble accessing COVID vaccines, tests, and treatments because the government will no longer control supplies. So if your pharmacy doesn’t order enough supplies — or if manufacturers don’t produce enough — you may have to wait for supplies to replenish, which for some people can be life-threatening.

People who are uninsured will lose virtually all guaranteed access to COVID tests, vaccines and treatments.

The Biden administration’s decision, effective May 11, comes just three days after House Republicans announced they would vote immediate termination of both emergency declarationswhich the president said “would be a serious disservice to the American people.”

An abrupt end to claims could strip tens of millions of people in the U.S. of their health insurance and eliminate billions of dollars in state Medicaid funding, the administration’s Office of Management and Budget said Jan. 30 statement. (Medicaid provides medical coverage through federal and state funding to low-income individuals and families.)

“In December, Congress enacted an orderly rollback of these rules to ensure that patients do not lose access to care unpredictably and that state budgets do not face a radical collapse,” the administration said. “If PHE is suddenly terminated it will sow confusion and chaos in this critical shutdown.”

The sudden change could also lead to disruptions in care and delays in payments, as hospitals and nursing homes that relied on the flexibility offered by emergency declarations will have to quickly set up new billing processes. People who use telehealth may also lose access to clinical services and medications, the administration said.

That’s why the Biden administration scheduled the declarations to expire in May to give people and health systems time to adjust.

Still, House Majority Leader Steve Scalise said it wasn’t worth waiting until May to end the declarations, adding that “the vast majority of Americans went back to work and resumed their lives months ago.” .

“House Republicans are making it clear that the days when the Biden administration could hide behind COVID to waste billions of taxpayer dollars on their unrelated, radical agenda are over,” Scalise said in statement published on Monday.

COVID continues to kill about 500 people in the U.S. every day, especially elderly and immunocompromised adults, although cases and hospitalizations have declined in recent weeks. Meanwhile, tens of thousands of people are experience lingering symptoms after infection Known as long covidand those with weakened immune systems are forced to find ways to protect themselves as most precautions against COVID have been lifted.

Here are the changes that may affect you the most The COVID pandemic continues.

You may have to pay for COVID tests

The current public health emergency requires private insurance companies to cover up to eight home COVID tests per person per month, as well as any test (PCR or rapid) that a doctor or clinic gives you, whether in-network — with some small exceptions and only after sooner tedious recovery process.

But after May, you may have to pay part or all of the cost for COVID tests, depending on how your insurer decides to cover them.

For example, your insurance company may choose to cover only one test per month, and you will be responsible for paying for some or all of the additional tests; may decide to cover your tests only at network providers or pharmacies; may apply test co-payments or charge deductibles; or it could continue to cover all your tests at no cost to you — “but that seems unlikely,” according to Cynthia Cox, vice president of the Kaiser Family Foundation, a nonprofit focused on national health issues.

This is why it will be extremely important to communicate with your insurance company.

“Call ahead and find out what the cost is at each location where you plan to get tested because we’ve seen some cases where the cost of a COVID test can be hundreds of dollars and in other cases it can be tens of dollars,” said Cox, who conducts economic and policy research on the Affordable Care Act and its effects on private insurers. “Understand your coverage, find out what your insurer does, and then possibly shop around if you’re not sure how much it’s going to cost you.”

Medicare — federal health insurance for people age 65 and older — will no longer cover the full cost of at-home COVID tests, which AARP cited as the main reason it opposes ending the public health emergency. (Tests issued by medical providers will be covered.)

“PHE must continue until cases are reduced and an orderly transition is in place to ensure all Americans can get the care they need,” the association said in a statement sent to Congress on Tuesday. “Older Americans rely on PHE-authorized programs and flexibilities to protect them, such as Medicare coverage for at-home COVID testing and coverage of certain treatments. Their health and well-being should be valued as much as Americans of any other age group.

If you are enrolled in Medicaid or Children’s Health Insurance Programyour COVID tests will continue to be covered, including home tests, until around May 2024, according to the Kaiser Family Foundation. You may then have to pay some of the costs.

If you don’t have health insurance, you will no longer have access to free COVID testing through the Medicaid Eligibility Pathway introduced by the public health emergency.

Reduced access to COVID tests could mean fewer tests are being done, even as the coronavirus continues to spread, and could also prevent people from getting the treatment they need. (Paxlovid(for example, it should be taken immediately after a diagnosis of COVID and within five days of the onset of symptoms.)

Testing your child every day to make sure his infection is gone before you send him back to school can protect other children from getting sick, Cox said. But if you had to pay a lot of money for each test, some parents may be unwilling or unable to take these precautions.

The same thinking applies to access to treatment, Cox added. “If people don’t have access to the tests they need to determine if they have COVID, and then quickly start Paxlovid, then they may not be able to get that treatment, which could lead to a worse health outcome or need from hospitalization that I wouldn’t otherwise have — and then be left with even more costs,” she said.

You may also have to cover medical expenses

When it comes to COVID treatment, people with Medicare or no insurance at all will face the biggest changes after May, according to Cox.

Medicare enrollees currently pay nothing for COVID treatment, including infusions of monoclonal antibodies and oral antivirals such as Paxlovid. (Technically, no one has to pay for Paxlovid because there are still federally purchased doses available for free.) After May, that will no longer be the case. Some people with Medicare may have to pay some of their medical costs after the federal supply runs out.

If you don’t have insurance, you’ll have to pay for any COVID treatments you might need (if you haven’t already paid for them because of the Medicaid eligibility pathway) when the federal supply runs out.

If you have Medicaid, your COVID treatment services will still be covered until around May 2024 (then you may face cost sharing). However, if at this point some treatments like Paxlovid are still under emergency use authorization, which experts don’t believe will be the case, then each state will have to decide whether or not to cover the costs.

Americans with private insurance who need COVID treatment will be responsible for paying for anything their insurer doesn’t cover, but they can still get free treatment as long as supplies purchased by the federal government run out.

Vaccines are still free for all…for now

All of the COVID vaccines and boosters administered so far have been purchased by the federal government, so they’ve been free for everyone, regardless of insurance — and will continue to be so even after the public health emergency ends.

It is until the free doses are exhausted, but Cox said he doesn’t think that will happen anytime soon because Americans are slowly rolling up their sleeves; regarding 69% of the population is vaccinated with two doses and only 15.5% with the updated bivalent booster.

Pfizer said consumers could pay anywhere between $110 and $130 for a dose of its vaccine. Moderna said it would charge between $64 and $100 per dose. It is three to four times more expensive than what the government paid, and it’s not particularly good news for the uninsured given the FDA’s proposal most people should get one COVID vaccine a yearsimilar to the flu shot.

Most people with private insurance can get free vaccines after the federal supply runs out, “but there may be some unusual exceptions,” Cox said. Just make sure the clinic or provider you visit is in network with your insurance.

If you participate in Medicaid or CHIP, your COVID vaccine and administration is considered a mandatory benefit that will be covered.

Medicare will also pay for your vaccine and administration after the free doses are used up.

If you don’t have insurance, you may be able to find a free COVID vaccine through a community health center. Otherwise, you will have to pay the full price.

Telemedicine will be limited for some people

The public health emergency introduced many flexible options for telemedicine during the pandemic, most of which have been extended until the end of next yearbut some will expire after May.

Some providers will no longer be able to prescribe controlled substances such as pain medications through a telemedicine appointment, according to Cox. After May, some patients may need to see their provider in person first.

And depending on the state you live in, you may not be able to meet with a particular health care provider via telemedicine if they practice in another state after the public health emergency ends.

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