The Biden administration ended the pandemic’s classification as a public health emergency on May 11, a move that ushers in an elaborate wave of policy changes that may complicate Americans’ testing and treatment options for the disease.
“The one word I have to describe this all is ‘confusion,’” said Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco. “It’s confusing already to know where to get a test, who’s paying for what, what’s my co-pay going to be. Now it’s going to be a complex equation.”
Here’s how the end of the public health emergency could affect you.
If you have private insurance
The biggest change most people will notice is that they will likely no longer be eligible for eight free at-home Covid tests each month through their insurance, said Jennifer Kates, a senior vice president at KFF, formerly known as the Kaiser Family Foundation. People with private insurance will probably have to pay full price for at-home Covid tests at drugstores. Those who stocked up before the end of the emergency declaration should make sure to note the expiration date on any home tests they’ve hung onto.
People with private insurance may also have new co-pays for P.C.R. tests, even those ordered by their doctor, Dr. Kates said. It is not yet clear just how expensive these co-pays will be, but they will likely be comparable to the costs of any prescriptions or tests recommended by a doctor, she said. A KFF analysis found that the median cost of an outpatient Covid-19 test was $45 in 2021 for people with large, employer-based health plans. For now, Paxlovid will be free while the government maintains a stockpile, but if the treatment moves to the commercial market, patients may have co-pays.
Costs could vary from plan to plan, said Jose Francisco Figueroa, an assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health, including those for treatments prescribed via telehealth.
Vaccines will also continue to be free until they move to the commercial market. After that, those with private insurance will not have to pay anything for Covid vaccines, whether they are being vaccinated for the first time or are receiving booster shots, as long as they obtain them from an in-network provider, Dr. Kates said. That is because of policy changes the Affordable Care Act introduced before the pandemic, she said.
If you are on Medicare
People on Medicare will mostly be able to receive P.C.R. and antigen tests ordered by their doctors for free. They will still be able to obtain free Covid vaccines, because of the CARES Act and regulations that the Centers for Medicare and Medicaid Services introduced during the pandemic, Dr. Kates said. The end of the public health emergency will not change access to antiviral treatments like Paxlovid for people on Medicare, according to the Centers for Medicare and Medicaid Services. Once the federal supply of Paxlovid is depleted, people on Medicare may have co-pays for the treatment.
People on Medicare had been eligible for eight free at-home Covid tests each month as well, Dr. Kates said, but those on traditional Medicare will now have to pay the full cost of at-home tests. And in most cases, people on Medicare will be able to continue seeing providers virtually using telehealth through Dec. 31, 2024.
If you are on Medicaid
People on Medicaid will be able to access Covid tests and treatments at no cost until 2024, Dr. Kates said, because of a provision in the American Rescue Plan. They will also be able to obtain free vaccines, she said. Medicaid coverage for telehealth treatments will continue to vary from state to state. Most states have made, or plan to make, some provisions that enabled patients to get treatment via telehealth during the pandemic permanent, said Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF.
If you are not insured
In some states, people without insurance have been able to obtain temporary Medicaid coverage for tests and treatments, but states are now redetermining which people qualify for Medicaid coverage. The Biden administration has announced a program to fund free vaccines for people without insurance.
Some people without insurance were already struggling to access Covid care even before the public health emergency expired. “This is the group that falls through every crack in our system,” said Natalie Davis, a founder and the chief executive officer of United States of Care, a nonprofit that supports expanding access to health care. These people will most likely need to rely on public health programs, like community health centers, although the availability of those programs may vary depending on their location. “Different states will have different safety nets,” Dr. Chin-Hong said. “It’s going to end up being very regional.”
Ultimately, while health policy experts have raised concerns about the end of the Covid public health emergency, it may just reinforce the mind set many people have embraced for months, if not years, said Dr. Paul Offit, a vaccine expert at the Children’s Hospital of Philadelphia.
“The American public already believes this pandemic is over,” he said.