The COVID-19 public health emergency and national emergency declared in 2020 have been extended to May 11 — but at that point, both emergencies will expire, per a January 30 announcement from the Biden Administration.
For context, the Secretary of the U.S. Department of Health and Human Services can declare a public health emergency in cases such as significant outbreaks of an infectious disease or a bioterrorist attack, per the Medicaid and CHIP Payment and Access Commission.
This allows the Secretary to make grants, modify the practice of telemedicine, enter into contracts, conduct and support investigations into the cause/treatment/prevention of the disease, and more.
With the expiration of the declaration, a few major health policies will change, while some will remain the same. Here’s what you can expect when the public health emergency ends, per the Kaiser Family Foundation.
Since the supply of federally purchased vaccines determines the availability, access, and costs of COVID-19 vaccines (including boosters) — not the public health emergency — nothing will change here as long as federally purchased vaccines continue to be available.
This means that COVID-19 vaccines will remain free to everyone, regardless of their insurance coverage. As long as that federal supply lasts, vaccine providers aren’t allowed to deny anyone a federally purchased vaccine based on their coverage or network status. They also can’t charge out-of-pocket costs.
Once the federal supply of COVID-19 vaccines is gone, most people with public and private insurance will still be able to get them free of charge, due to the Affordable Care Act and other recent legislation. That said, costs may become a barrier for those who are uninsured or underinsured. Privately insured individuals will need to make sure their provider is in-network.
At-Home COVID Tests
People with traditional Medicare will no longer receive free at-home tests after May 11. If you have private insurance and Medicare Advantage (private Medicare plans), your insurer may continue to voluntarily cover those tests, but you’ll no longer be guaranteed free at-home tests.
The tests will be covered at no cost through September 2024 for those on Medicaid, but coverage will vary by state after that point.
Uninsured people in most states are already paying full price for at-home tests. They may be able to find them at a free clinic, community health center, library, or other local organization. The federal government has also provided tests through the mail, but that supply is declining.
PCR and Rapid Tests From Health Care Professionals
Most insured people will still have coverage of COVID tests ordered or administered via their doctor, but these tests may no longer be free. Here’s how you may be affected, based on your insurance.
- Traditional Medicare: There won’t be a cost for the test itself, but the associated doctor’s visit could come with cost sharing.
- Medicare Advantage and Private Insurance: Both the test and associated doctor’s visit may be subject to cost sharing, depending on your plan. You may have a limit on your number of covered tests or may need to have tests done by an in-network provider.
- Medicaid: Tests will continue to be free through September 2024, but states may limit the number of covered tests or require small cost sharing.
- Uninsured: If you’re uninsured and in one of the 15 states that have adopted a temporary Medicaid coverage option, you’ll no longer be able to get testing services without cost sharing, since this program ends with the public health emergency. If you’re uninsured, you’ll have to pay full price for tests unless you can get tested through a free clinic or community health center.
Treatments like Paxlovid that are purchased by the federal government will continue to be free to all, regardless of your insurance coverage. This is based on the availability of the federal supply rather than the public health emergency.
Otherwise, you may start to have new cost-sharing requirements for COVID-19 treatments if you have public coverage. For instance, you may face cost-sharing for certain treatments if you have Medicare.
Meanwhile, Medicaid and Children’s Health Insurance Program (CHIP) programs will continue to cover any pharmaceutical treatments without cost sharing through September 2024. After that point, states may declare usage limits and nominal cost sharing.
Private insurers were never mandated to waive cost-sharing for COVID-19 treatments, and even though some did so on their own, most phased out those waivers more than a year ago. Many insured people already have to cost-share for hospitalizations and outpatient visits related to COVID-19 treatment.
Providers writing prescriptions for controlled substances were able to do so via telemedicine during the public health emergency, but in-person visits will be required after May 11. Temporary waivers of licensing requirements — and the end of those waivers connected to the expiration of the public health emergency — may mean that certain providers can no longer practice remotely.
Penalties around providers using technologies that don’t comply with federal privacy and security rules will also tighten, restricting the use of telehealth to “HIPAA compliant” technologies and communication. (For instance, this may limit your doctor from communicating with you through telehealth on your smartphone.)
What’s the same: Before the pandemic, most private insurers covered telemedicine. And with Medicaid, states have the ability to cover telehealth without federal approval — and most states have made or will make certain Medicaid telehealth flexibilities permanent fixtures.
The Bottom Line
For many people, the most noticeable change will be the end of 100-percent free testing (this may delay timely COVID-19 diagnoses or treatment for some, if they go without testing due to cost) and the end of telemedicine to prescribe controlled substances.
Larger changes will come along when the federal government’s supplies of tests, vaccines, and treatments are depleted, but the timing of that is not yet known — and it’s not tied to the public health emergency.
It’s also important to know that continuous enrollment for Medicaid, which led to record-breaking enrollment, was once connected to the end of the public health emergency. However, new legislation decoupled this provision from the public health emergency and it is set to end on March 31, 2023.
States can start to disenroll individuals from Medicaid as early as April 1, 2023, though many will take a year to actually complete those disenrollments. It’s estimated that millions will lose Medicaid coverage during that period of time, per KFF.
How Our Community Feels
We asked our patient community, “How do you feel about the end of the COVID emergency order in the U.S. and its impact on you as someone with chronic disease?” While some members felt “it was about time” others noted that these new emergency orders made them feel “expendable” and left behind. Still, others are taking in stride and continuing to doing their best to stay protected.
Here are a few of the many responses:
- @donnawayjoan: “It Infuriates me. With the most contagious variants yet circulating freely, I find this the most frightening stage yet.”
- @kristina.ht: “Unfortunately, we are seen as expendable because society deems anyone with chronic health issues as defective, as if we chose this for ourselves. It’s shameful, but doesn’t surprise me.”
- @suzyszasz: “Terrible decision. 500 people dying per day in the US is not an indicator that this is ‘over.’”
- N O’Brien: “It’ll start costing us oodles of money now for testing and treatment, so that makes all that is so difficult even more difficult. I continue to do my best to protect myself and pay attention. It’s never been easy since the beginning, and it won’t get any easier.”
- @ tmorse895: “I want to scream: Wear a mask.”
- @rosaclaire91: “It’s heartbreaking to know we are being completely abandoned. Just because we ignore it doesn’t mean it’s not still happening.”
- @jenzelnick: “Declaring an emergency over does not make it go away. We no longer have Evusheld or monoclonal antibodies approved as treatment. I had to switch careers to WFH (my workplace is hybrid but I have an accommodation). My whole life has changed, as has my family’s.”
- @juliakstarkey: “I’m not ok with moving on — I have enough chronic issues without getting COVID over and over.”
- @celinadennette: “It’s about time.”
- @melissamgibbs: “I’m glad they are ending it; it’s been way too long. Let’s move along.”
- @lagata58 “I’m glad! Let’s start to move on!”
- @aliespice “It’s my responsibility to take care of myself regardless of what any governing body says. I focus on the things that are in my control.”
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The End of the COVID-19 Public Health Emergency: Details on Health Coverage and Access. Coronavirus (COVID-19). Kaiser Family Foundation. https://www.kff.org/policy-watch/the-end-of-the-covid-19-public-health-emergency-details-on-health-coverage-and-access/.
Federal emergency authorities. Medicaid and CHIP Payment and Access Commission. Accessed February 5, 2022. https://www.macpac.gov/subtopic/federal-emergency-authorities/.
Statement of Administration Policy. Executive Office of the President. January 30, 2023. https://www.whitehouse.gov/wp-content/uploads/2023/01/SAP-H.R.-382-H.J.-Res.-7.pdf.