Lena H. Sun and Amy Goldstein
The Biden administration will end the public health emergency for the coronavirus pandemic on May 11.
Starting in early 2020, the emergency declaration, along with subsequent declarations, legislation and administrative actions, gave the federal government flexibility to waive or modify certain rules in the Medicare and Medicaid programs as well as in private health insurance. The goal has been to help the nation fight the worst public health crisis in a century and help some patients get care in a time of shutdowns.
As this long emergency period expires, experts say, the biggest impact for consumers will be the end of free coronavirus tests — both at-home tests and those performed by clinicians and analyzed by commercial labs — with broad implications for people’s ability to get timely covid diagnoses, prevent disease transmission and track the virus.
A recent study from the Centers for Disease Control and Prevention found that one-third of U.S. households used free at-home covid-19 diagnostic tests from a program the White House launched in January 2022 that allowed rapid antigen tests to be ordered at no cost to consumers through the U.S. Postal Service. The study suggested that, without the kits, 1 in 4 adults who used a test would likely to have gone untested.
Here’s how major health policies will be affected when the public health emergency ends.
At-home (over-the-counter) tests may become more costly for people with insurance. The public health emergency required insurers to reimburse for up to eight antigen tests a person per month. After May 11, older Americans with traditional Medicare will no longer be able to get free, at-home tests. People with private insurance or Medicare Advantage (private Medicare managed-care plans) will no longer be guaranteed free at-home tests, but some insurers may continue to voluntarily cover them.
For those on Medicaid, at-home tests will be covered at no cost through September 2024. After that date, home-test coverage will vary by state.
In addition, 18 states and U.S. territories have used their Medicaid programs temporarily to provide people who are uninsured free coronavirus testing services, including at-home tests, but that program will end with the public health emergency.
People who cannot afford at-home tests, which cost about $25 for a box of two tests, may continue to be able to find them at a free health clinic, community health center, public health department, library or other local organization.
Although coronavirus tests ordered or administered by a health professional and analyzed by laboratories will still be covered for most insured people, these tests may no longer be free.
For people with traditional Medicare, there will be no cost for the test itself, but there could be cost-sharing for the associated doctor’s visit. For people with Medicare Advantage or private insurance, both the test and the associated doctor’s visit might be subject to cost-sharing, depending on the health plan. Additionally, some insurers might begin to limit the number of tests they cover or require tests be done by in-network providers. People enrolled in skimpy health plans that do not meet Affordable Care Act benefits rules will have no guarantee of coverage for tests and may have to pay full price.
People with Medicaid will continue to have access to free testing services through September 2024, after which point, states may limit the number of covered tests or impose nominal cost-sharing.
Uninsured people in the 18 states and territories that have adopted the temporary Medicaid coverage for them will no longer be able to obtain any type of free coronavirus testing services as this program ends with the public health emergency.
Coronavirus vaccines
Vaccines will remain free for people with and without insurance. That is partly because the availability and costs of coronavirus vaccines, including boosters, are determined by the supply of federally purchased vaccines, not the public health emergency. So as long as federally purchased vaccines last, coronavirus vaccines will remain free to all people, regardless of insurance coverage. Providers of federally purchased vaccines are not allowed to charge patients or deny vaccines based on the recipient’s insurance status.
Even after the federal supply of vaccines is gone, which federal officials expect to happen in the fall, vaccines will continue to be free of charge to the vast majority of people with private and public insurance. Free coverage is required for all vaccines recommended by the CDC. For the uninsured, the Biden administration announced a $1.1 billion program to ensure access to free coronavirus vaccines and treatments through December 2024.
FDA emergency use authorization
The ending of the public health emergency won’t affect products, including coronavirus vaccines, treatments and tests, that have been cleared under the Food and Drug Administration’s emergency use authorizations, which allow the agency to authorize medical products more quickly than under the traditional approval process. In addition, the agency’s ability to use emergency authorizations in the future won’t be affected, including for a retooled coronavirus vaccine that’s likely to be used in the fall. The agency’s emergency use authorization is tied to a separate emergency declaration (section 564 of the federal Food, Drug and Cosmetic Act), which is not expiring.
Covid treatment
Medicare beneficiaries will not face cost-sharing requirements for certain covid pharmaceutical treatments, such as the antiviral Paxlovid, after May 11, as long as those doses were purchased by the federal government. Medicaid and the Children’s Health Insurance Program, meant for youngsters in working-class families, will continue to cover all pharmaceutical treatments with no-cost sharing through September 2024. After that, states may impose utilization limits and nominal cost-sharing.
Any pharmaceutical treatment doses purchased by the federal government will remain free to all, regardless of insurance coverage, based on availability. The United States has millions of doses of oral antivirals, such as Paxlovid, which are expected to last months. Once that stockpile is gone, the medications’ prices will be determined by the manufacturers. The price that individuals pay at the pharmacy will depend on their health insurance. For older Americans on Medicare, all FDA-allowed medicines to treat covid will be covered through Part D (drug coverage plans), which about three-fourths of the 65 million people on Medicare have. Such plans can require cost-sharing or limit the coverage.
Most insured people already face cost-sharing for hospitalizations and outpatient visits related to covid treatment. Private insurers were never required to waive cost-sharing for any covid treatment. Although some did so voluntarily, most insurers had already phased out these benefits more than a year ago.
Telemedicine
The Drug Enforcement Administration is extending public health emergency flexibilities for prescribing controlled medications via telemedicine. The agency has not determined how long the extension will last. During the emergency, providers writing prescriptions for controlled substances — such as the attention-deficit/hyperactivity disorder drug Adderall; the addictive painkiller OxyContin; the anti-anxiety medicine Xanax, and the opioid addiction treatment drug buprenorphine — were allowed to do so via telemedicine. The Biden administration had proposed new rules to take effect as soon as the emergency ends. If the rules go into effect as drafted, patients would eventually need in-person evaluations for certain medications like Adderall and could get a 30-day supply of other drugs like Xanax before having to see a provider in person. The rules include a 180-day grace period to allow patients to come into compliance with the new in-person requirements.
Because of the pandemic, all states and D.C., temporarily waived some aspects of state licensure requirements so that providers with equivalent licenses in other states could practice remotely. Some states tied those policies to the end of the federal public health emergency so the waivers may end unless states change their policies.
The Department of Health and Human Services temporarily waived penalties against providers using technologies that don’t comply with federal privacy and security rules in the provision of telehealth services during the public health emergency. Enforcement of these rules when the public health emergency ends will restrict the provision of telehealth to “HIPAA compliant” technologies and communication productions.
Telehealth appointments for Medicare beneficiaries, especially those in rural areas or other places where health care is scarce, will remain covered through 2024, because of a spending bill approved by Congress late last year. For people on Medicaid, telehealth appointments often were covered before the pandemic and will remain available after May 11.
Data reporting
Since early in the pandemic, HHS has been able to compel labs to report the results of coronavirus tests to the CDC. That has been crucial to understanding how the shape of the pandemic has evolved, relying on positive and negative test results. States have also been sharing vaccine administration data with the CDC.
That lab reporting requirement goes away with the end of the public health emergency. Similar reporting of positive test results by hospitals and other data, such as the number of hospitalized covid-19 patients and number of N95 masks, will continue through the end of April 2024. But after May 11, hospitals will report fewer types of data, and they will report weekly instead of daily.
States also will no longer be required to submit data on vaccine administration, making it more difficult for the federal government to have a national picture of vaccinations and to evaluate vaccine effectiveness. The CDC is working to sign voluntary data use agreements with states to encourage them to share the data through the end of this year.
Pharmacy shots
A federal law that protects manufacturers and providers of covid-19 countermeasures from malpractice claims was broadened to allow more professionals — pharmacists, pharmacy technicians and pharmacy interns — to vaccinate people as young as 3 years old against the coronavirus, influenza and routine childhood immunizations. HHS plans to extend this protection from liability through December 2024, but not for routine childhood shots, unless state law allows it. That means parents will no longer be able to use the convenience of a pharmacy visit for childhood immunizations but will have to take their children to a health-care provider.
David Ovalle, Daniel Gilbert and Laurie McGinley contributed to this report.
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