The Biden Administration's decision to end the national and public health emergencies related to the COVID-19 pandemic on May 11 means the end of free COVID tests and masks and treatments as well as some telemedicine practices.
By ending two emergency declarations, the government is saying it no longer needs to respond to the COVID-19 virus with extraordinary measures in place over the past three years and will rely instead on standard healthcare practices. Already, the U.S. Food and Drug Administration (FDA) proposed in January switching to annual COVID-19 booster shots for most people.
The national and public health emergencies were scheduled to expire on March 1 and April 11, respectively. The Biden Administration says it extended the expiration date to May 11 to align with its commitment to give at least 60 days' notice prior to the end of the emergency. As government agencies gear up to minimize disruptions to COVID-related healthcare services, here's what to expect after May 11:
- National and public health COVID-19 emergency declarations will end on May 11, 2023.
- Access to free COVID-19 tests, masks, and some treatments will end.
- COVID-19 vaccines will still be available free of charge.
- COVID treatments including Pavloxid will shift from free to a cost-sharing basis for some people.
- Some telemedicine services will end.
- COVID-19 related healthcare costs for most people will increase as a result of the end of the emergency declarations.
Impact: None, at least not anytime soon.
- The availability of free COVID vaccines including boosters is based on the supply of federally purchased vaccines and isn't related to either emergency declaration.
- As long as federally purchased vaccines last, they'll remain free for everyone, whether insured or not.
- Once the supply of government-purchased vaccines runs out, uninsured and underinsured individuals may have to bear some or all of the cost of receiving vaccines.
- Most others will still have free access.
At-home COVID Tests
Impact: Tests may no longer be free.
- After May 11, those on traditional Medicare won't receive free at-home tests.
- People with private insurance and Medicare Advantage won't be guaranteed free tests, but some insurers may voluntarily provide them.
- Medicaid recipients will get free tests through September 2024. After that, coverage will vary by state.
- Uninsured individuals weren't eligible for free tests under federal emergency measures but many have been able to obtain them from community health centers, free clinics, and public health departments.
What you need to know
A limited supply of free COVID tests have been provided through the mail by the federal government. That source may not be available much longer.
Medically Necessary PCR and Rapid Tests
Impact: Variable increases depending on status and coverage.
- Those with traditional Medicare won't be billed for the cost of the test but may be subject to cost-sharing for the office visit.
- If you have Medicare Advantage or private insurance, the test and office visit might be subject to cost-sharing, depending on your plan. Some insurers might limit the number of covered tests or require that these tests be done by in-network providers.
- People in grandfathered or non-ACA-compliant plans won't be guaranteed coverage and may have to pay full price for the test.
- People on Medicaid will receive tests for free through September 2024. At that point, some states may limit the number of covered tests or impose cost-sharing.
- If you're uninsured and a resident of one of the 15 states that adopted the temporary Medicaid coverage option, you won't be able to obtain COVID-19 testing services, including free at-home tests, with no cost-sharing, since that coverage ends with the expiration of the public health emergency.
- Uninsured residents of the other 35 states will pay full price for tests unless they receive service from a community health center or free clinic.
Impact: Increased costs in May or October, depending on status.
- People with public coverage may 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 cover all pharmaceutical treatments with no-cost sharing through September 2024. After that date, these treatments will be covered; however, states may impose utilization limits and nominal cost-sharing.
- Any pharmaceutical treatment doses (e.g. Paxlovid) purchased by the federal government are still free to all, regardless of insurance coverage. That's based on the availability of the federal supply and isn't 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.
Impact: Flexibilities with telehealth services will remain for some, end for others.
- In-person visits will be required after May 11 for prescriptions for controlled substances. Previously, they were permitted via telemedicine.
- The ability to practice medicine remotely over state lines will end in states where the practice was tied to the health emergency declarations. Some affected states may change their policy to allow the practice.
- Rules regarding federal privacy and security were temporarily waived by the Department of Health and Human Services during the pandemic. After May 11, all telehealth services will have to be “HIPAA compliant.”
- Originally, telehealth for Medicare beneficiaries was tied to the public health emergency but thanks to the Consolidated Appropriations Act of 2023 will remain unchanged through December 31, 2024.
- Most private insurers covered telemedicine before the pandemic. That isn't likely to change.
- States are authorized to cover telehealth under Medicaid without federal approval and most plan to make some of the pandemic telehealth policies permanent.
The Bottom Line
For most people, the end of the emergency declarations means higher costs for COVID tests including at home and in a healthcare professional's office. Experts say this could result in people going without needed testing due to cost.
The depletion of government-purchased supplies of vaccines and pharmaceutical treatments (Pavloxid) could affect public health unless Congress acts to increase the supply of vaccines and treatments.
Since increased enrollment in Medicaid was tied to the emergency declarations, the breaking of that tie on March 31, 2023, due to new legislation means states will begin unenrolling people from Medicaid as soon as April 1, 2023, further exacerbating healthcare issues for those individuals, which could number in the millions, according to the Kaiser Family Foundation.