What to know as the COVID-19 public health emergency ends
An advertisement touts COVID-19 rapid testing outside of the AFC Urgent Care in Patchogue on Jan. 11, 2022. Credit: Newsday/Steve Pfost
For more than three years, the declaration of a public health emergency due to the coronavirus pandemic has empowered the federal government to modify, waive or suspend existing rules for private medical insurance, Medicare and Medicaid, and other long-standing policies.
The Biden administration is letting that declaration lapse Thursday. Here are some questions and answers about what’s changing — and what isn’t.
Must insurance plans continue to cover COVID-19 diagnostic testing?
No, group insurance plans will no longer be required to fully cover over-the-counter tests or PCR tests, as had been required since early in the pandemic, according to the U.S. Department of Labor.
Currently, plans are required to cover at least eight antigen tests — the at-home kind — per month. But no law is stopping plans from keeping the status quo and choosing to cover testing anyway at no cost to the plan participant, and that’s the government recommendation.
“It will fall in line with a lot of other routine testing that if your provider covers it you’re good, if not you may have to scramble to get whatever test is being offered,” said Dr. Alan M. Bulbin, director of infectious disease at Catholic Health’s St. Francis Hospital.
How about for people on Medicaid and Medicare who want at-home tests?
At-home tests for people with Medicaid will be fully covered until September 2024, and then it’ll be a state-by-state determination. Traditional Medicare is ending the free-at home tests. For those with Medicare Advantage, it depends on your insurance.
How about for PCR tests?
For people with traditional Medicare, the test itself won't cost anything to the patient, but there might be a charge for a visit to the doctor to get it done.
But the COVID-19 vaccine will still be covered at no cost for insurance plans, right?
Yes, in general, but while many plans must still keep covering the vaccine, the mandate will apply only to getting the shot from an in-network provider. The current requirement to cover vaccines essentially from any provider will generally lapse, according to the Labor Department. But as long as the federally purchased vaccine supply lasts, those vaccines will continue to be free to all.
What happens to the extensions of time frames for open enrollment, electing COBRA continuation coverage and paying COBRA premiums?
Those lapse on July 10 — 60 days after the official end to the national emergency. The lapsed extensions means that time frames — which differ for each type at issue — revert to pre-pandemic periods.
How about for Medicaid or Children's Health Insurance Program (CHIP) coverage?
Many of those enrolled in this government insurance began losing eligibility for that coverage after March 31, ending the general policy of state Medicaid agencies not to terminate coverage for anyone who was covered since March 18, 2020.
What does the end of the declaration mean for COVID-19 treatment?
Patients with public coverage such as Medicare might need to start paying part of the cost of COVID-19 drugs. Medicare and CHIP beneficiaries will keep covering those drugs through September 2024.
After that, “these treatments will continue to be covered; however, states may impose utilization limits and nominal cost-sharing,” according to the Kaiser Family Foundation. There isn’t much changing with private insurance and treatment, because there generally never was a coverage mandate for private insurers to make treatment free.
With Bart Jones
Matthew Chayes, a Newsday reporter since 2007, covers New York City.
