The End of the COVID-19 Public Health Emergency: Details on Health Coverage and Access

On Jan. 30, 2023, the Biden Administration announced it will end the public health emergency (and national emergency) declarations on May 11, 2023. Here’s what major health policies will and won’t change when the public health emergency ends.

Vaccines

What’s changing: Nothing. The availability, access, and costs of COVID-19 vaccines, including boosters, are determined by the supply of federally purchased vaccines, not the public health emergency.

What’s the same: As long as federally purchased vaccines last, COVID-19 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 coverage or network status.

Although a federal rule temporarily required private insurers to reimburse out-of-network providers for vaccine administration during the public health emergency, vaccine access will be unaffected by insurers ending these payments, as long as federal supplies last, because vaccine providers are not allowed to deny anyone a federally purchased vaccine based the recipient’s coverage or network status and must not charge any out-of-pocket costs.

Due to the Affordable Care Act and other recent legislation, even after the federal supply of vaccines is gone, vaccines will continue to be free of charge to the vast majority of people with private and public insurance. However, costs may become a barrier for uninsured and underinsured adults when federally purchased doses are depleted, and privately insured people may then need to confirm their provider is in-network. For more on what happens after the federal supply of vaccines runs dry, see our briefs on the commercialization of COVID vaccines and the expected growth in prices for COVID vaccines.

Importantly, the Food and Drug Administration (FDA)’s emergency use authorizations for COVID-19 vaccines (and treatments and tests) will remain in effect, as they are tied to a separate emergency declaration, not the public health emergency that ends in May.

At-home COVID tests

What’s changing: At-home (or over-the-counter) tests may become more costly for people with insurance. After May 11, 2023, people with traditional Medicare will no longer receive free, at-home tests. Those with private insurance and Medicare Advantage (private Medicare plans) no longer will 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.

A temporary Medicaid coverage option adopted by 15 states has given uninsured people access to COVID-19 testing services, including at-home tests, without cost-sharing but that program will end with the public health emergency.

What’s the same: Uninsured people in most states were already paying full price for at-home tests as they weren’t eligible for the temporary Medicaid coverage for COVID testing services. Uninsured and other people who cannot afford at-home tests may still be able to find them at a free clinic, community health center, public health department, library, or other local organization. Additionally, some tests have been provided by mail through the federal government, though supply is diminishing.

PCR and rapid tests ordered or administered by a health professional

What’s changing: Although most insured people will still have coverage of COVID tests ordered or administered by a health professional, 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 and private insurance, the test and the associated doctor’s visit both might be subject to cost-sharing, depending on the plan. Additionally, some insurers might begin to limit the number of covered tests or require tests be done by in-network providers. People in grandfathered or non-ACA-compliant plans will have no guarantee of coverage for tests and may have to pay full-price.

• For people with Medicaid, there will continue to be free tests through September 2024, after which point, states may limit the number of covered tests or impose nominal cost-sharing.
• Uninsured people in the 15 states that have adopted the temporary Medicaid coverage option will no longer be able to obtain COVID-19 testing services, including at-home tests, with no cost-sharing as this program ends with the public health emergency.

What’s the same: Uninsured people in most states were not eligible for the temporary Medicaid pathway for COVID testing and therefore will continue to pay full price for tests unless they can get tested through a free clinic or community health center.

COVID Treatment

What’s changing: People with public coverage may start to face new cost-sharing for pharmaceutical COVID treatments (unless those doses were purchased by the federal government, as discussed below). Medicare beneficiaries may face cost-sharing requirements for certain COVID pharmaceutical treatments after May 11. Medicaid and CHIP programs will continue to cover all pharmaceutical treatments with no-cost sharing through September 2024. After that date, these treatments will continue to be covered; however, states may impose utilization limits and nominal cost-sharing.

What’s the same: Any pharmaceutical treatment doses (e.g. Paxlovid) purchased by the federal government are still free to all, regardless of insurance coverage. This is based on the availability of the federal supply and is not affected by the end of the public health emergency.

Most insured people already faced cost-sharing for hospitalizations and outpatient visits related to COVID treatment. Private insurers were never required to waive cost-sharing for any COVID treatment. Though some did so voluntarily, most insurers had already phased out these waivers more than a year ago.

Telemedicine

What’s changing: Some flexibilities associated with providing health care via telehealth during the public health emergency will end.

• During the public health emergency, providers writing prescriptions for controlled substances were allowed to do so via telemedicine, but in-person visits will be required after May 11.
• 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 via telehealth. Some states tied those policies to the end of the federal public health emergency so those policies may end unless those states change their policy.
• The Department of Health and Human Services temporarily waived penalties against providers using technologies that don’t comply with federal privacy and security rues 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 so-called “HIPAA compliant” technologies and communication productions.

What’s the same: Expanded telehealth for Medicare beneficiaries was once tied to the public health emergency but, due to recent legislation, will remain unchanged through December 31, 2024. Most private insurers already covered telemedicine before the pandemic. In Medicaid, states have broad authority to cover telehealth without federal approval. Most states have made, or plan to make, some Medicaid telehealth flexibilities permanent.

Discussion

Overall, the widest ranging impact from the end of the public health emergency will likely be higher costs for COVID tests – both at-home tests and those performed by clinicians. As many Americans delay or go without needed care due to cost, the end of free COVID tests could have broad implications for the people’s ability to get timely COVID diagnoses or prevent transmission. Other changes to health policies that are tied to the public health emergency, national emergency, and other declarations are discussed in more detail in our earlier brief.

Further, and potentially more significant, changes will come when federal supplies of vaccines, treatments, and tests are depleted, though the timing of that is yet to be determined and is not tied to the public health emergency. The Biden administration has announced that it has no further funding for vaccines, tests, or treatments, and that Congress would need to make more funding available.

Importantly, continuous enrollment for Medicaid enrollees – which has led to record-high enrollment in Medicaid – was once tied to the end of the public health emergency. However, recent legislation decoupled this provision from the public health emergency and ends continuous enrollment on March 31, 2023. States can begin disenrolling people from Medicaid as early as April 1, 2023, though most states will take a year to complete these disenrollments. KFF has estimated that millions of people will lose Medicaid coverage during this unwinding period.