We have been dealing with COVID-19 for the past three years, and while people are still being infected, the public health emergency (PHE) declared in 2020 is officially ending on May 11, 2023. This will affect millions of Americans and their health care.
When the PHE ends, things could change for your clients’ coverage. Here are the major differences you need to know.
What Will Stay the Same
The COVID-19 PHE may be ending, but that doesn’t mean all of the United States’ efforts to tackle the virus will come to a halt.
Vaccines and Treatments
The Department of Health and Human Services (HHS) is committed to continued access to vaccines at no cost out of pocket, and certain treatments — including Paxlovid and Lagevrio — will be generally unaffected by the PHE ending. Medicare Part B will continue fully covering COVID-19 vaccinations. Out-of-pocket costs for certain treatments may change over time, depending on a client’s specific health care coverage or state. Medicaid members may see access or costs related to these items change after September 30, 2024.
The end of the PHE will also not affect the Food and Drug Administration’s ability to authorize COVID-19 products for emergency use, and current products will remain in effect. Such products include tests, treatments, and vaccines.
Telehealth Visits
Many consumers have benefited from the coverage of services delivered via telehealth while staying socially distanced. For individuals living in rural areas with limited access to care, this is especially helpful. State rules vary when it comes to Medicaid services, but both Medicare and Medicaid will continue to have telehealth flexibilities when the PHE ends. Medicare beneficiaries will continue to have the enhanced flexibilities they gained over the pandemic through December 2024.
What Will Change?
Now that PHE is officially ending, there will, unsurprisingly, be changes to the availability of COVID-19 tests. While your clients will still be able to purchase over-the-counter (OTC) tests, it will cost them.
COVID-19 Tests
COVID-19 tests will be subject to a copay or coinsurance if ordered by an in-network provider. Free at-home COVID-19 tests will no longer be given to traditional Medicare beneficiaries after May 11, 2023. Some private insurers may continue to provide free at-home tests, but it’s not guaranteed. Purchasing OTC COVID-19 tests at a pharmacy will be an out-of-pocket cost.
COVID-19 at-home tests will be covered at no cost for Medicaid beneficiaries through September 2024, after which coverage will vary by state.
Special Notes for Clients Enrolled in Medicaid
If your clients are currently enrolled in a Medicaid or Children’s Health Insurance Program (CHIP) plan, their coverage could be at risk.
Automatic Medicaid Renewal Process After the Public Health Emergency
One of the biggest changes you’ll be dealing with revolves around those that qualified for Medicaid through the Families First Coronavirus Response Act (FFCRA), which allowed for continuous enrollment until the end of the month that the PHE ends. This means that beneficiaries could be losing coverage if they don’t qualify during the renewal process.
Tackling the Medicaid Renewal Process After the Unwinding
During the Medicaid unwinding, beneficiaries will have a chance to renew coverage if they lose it, but it’s important to be updated on their eligibility and the requirements. If your clients are going to be affected by the PHE, it’s important to be proactive once the Medicaid renewal starts. It’s estimated that around 15 million beneficiaries will be put in this position.
Losing coverage will trigger a special enrollment period (SEP) for your clients, which means they will have the opportunity to buy an Affordable Care Act (ACA) plan. The unwinding SEP lasts from March 31, 2023, to July 1, 2024. Your clients will have 60 days to enroll in new coverage.
The end of the PHE is coming soon, and it’s imperative to be prepared for some of your clients to lose coverage. Taking the steps to get educated will be good for your business and make your clients are ready for changes to come.
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