Forbes: How Does The End Of The Covid-19 Public Health Emergency Affect Health Insurance?
The Covid-19 crisis triggered a public health emergency, which gave the federal government authority to waive and change requirements related to private health insurance, Medicare, Medicaid and Children’s Health Insurance Program (CHIP) plans.
During the public health emergency, patients and health insurance members benefitted from a range of free and expanded services and benefits designed to prevent and minimize the impact of Covid. The end of the public health emergency may affect your out-of-pocket health costs, health insurance coverage and doctor visits.
What Was the Covid-19 Public Health Emergency?
A public health emergency is an adverse event, such as a pandemic, that compromises the health of the population and can cause widespread illness.
The Department of Health and Human Services (HHS) declared a public health emergency in January 2020 due to the outbreak of Covid. A public health emergency lasts for 90 days unless it’s renewed. The government renewed the Covid-19 public health emergency several times over the past three years, including its most recent renewal earlier this year.
A public health emergency declaration permits the HHS secretary to take specific actions in response to the emergency, such as:
- Access funds to fight an infectious disease.
- Investigate the cause, treatment or prevention of the disease.
- Waive certain health insurance requirements.
- Modify telemedicine practices.
“The emergency enabled federal, state and local jurisdictions to take specific measures they would not have been able to do otherwise, such as creating isolation and masking mandates as well as implementing other measures meant to help us better protect our population against this public health threat,” says Peter Wood, vice president of Planning and Government Affairs for Community Health of South Florida.
Why Did the Covid-19 Public Health Emergency End?
The Covid-19 public health emergency ended on May 11, 2023, largely because of the diminishing contagion rate for Covid and the decrease in hospitalization and mortality rates.
“The numbers reached levels that the CDC and other federal government entities determined were manageable enough so that the public health emergency could be retracted and the nation could begin getting back to normal,” says Wood.
The Covid-19 public health emergency ended mainly because of fewer reported cases, hospitalizations and deaths.
How Does the End of Covid-19 Public Health Emergency Affect Health Insurance?
The end of the public health emergency means you may see changes to your health insurance coverage and out-of-pocket expenses.
For example, you may soon pay for Covid-19 testing, Covid-related medications and telemedicine visits, depending on your health plan. Many people who were eligible for expanded Medicaid or CHIP coverage because of the emergency may also lose their eligibility this year.
How Does it Affect Covid-19 Vaccines?
Many health insurance plans will still be required to cover the costs of Covid-19 vaccines received from an in-network provider. But your insurance plan may require you to share the cost if you’re vaccinated by an out-of-network provider.
“For insured patients, if your plan is a non-grandfathered plan, it must continue to cover vaccines at no charge, as they are considered preventive services under the Affordable Care Act,” says Kim Buckey, vice president of Client Services for Optavise, an employee benefits provider based in Carmel, Indiana. “However, employers and plans will no longer be required to cover vaccines administered by out-of-network providers.”
Contact your health insurance company to find out if these vaccines will continue to be available free of charge.
How Does it Affect Covid-19 Tests?
Your health insurance plan is no longer obligated to cover the costs of Covid-19 diagnostic testing, including over-the-counter tests and in-person tests. You may have to pay for these tests either in full or partially, but consult your insurer to confirm your potential share of the cost.
Health plans may decide to cover Covid-19 tests administered by in-network health providers. But plans may put more of the costs on health plan members through coinsurance and health insurance deductibles, or demand prior authorization before tests are done, cautions Buckey.
She adds that most insurance companies will continue to cover lab tests for Covid, even if they don’t cover over-the-counter tests. They may limit the number of tests someone can get, require cost sharing or charge for the doctor’s visit but not the test itself.
How Does it Affect Covid-19 Medications?
People with private health insurance or a group health insurance plan, such as one through an employer, still have access to pandemic-related medications purchased by the federal government, such as Paxlovid and Lagevrio, without cost-sharing required, regardless of your health plan.
You will likely have access to those medications until the national supply runs out, even though the public health emergency has expired.
How Does it Affect Telehealth?
Covid led to more reliance on telemedicine appointments using smartphones, personal computers and tablets. Those with private or group health insurance may continue to benefit from low- or no-cost telehealth visits with physicians, depending on their plan’s coverage.
“Policies like reimbursing providers at the same rate for telemedicine and in-person services may have facilitated higher rates of telemedicine used during the pandemic,” says Brandy Lipton, associate professor and applied microeconomist with expertise in health economics and public policy at the University of California, Irvine. But Lipton warns those policies may change ultimately with the end of the public health emergency.
If your group or private health insurance plan already featured telehealth coverage, these benefits and what you pay will likely continue for the foreseeable future unless your plan changes the reimbursement rate for telehealth doctors.
Contact your health plan to determine if and to what extent telehealth visits, including telehealth mental health visits, will be covered and your potential out-of-pocket costs.
How Does it Affect Medicaid?
When the pandemic began, Congress enacted the Families First Coronavirus Response Act, which ensured that Medicaid programs maintain continuous enrollment of eligible recipients through the end of the Covid-19 public health emergency. With the emergency ending, Kaiser Family Foundation estimates that between 5 million and 14 million people may lose eligibility to Medicaid and CHIP.
If you lose Medicaid or CHIP coverage, you may be eligible to purchase a health care plan through the Affordable Care Act (ACA) marketplace, which is a government tool that lets you compare health insurance plans available in your area and select a plan that may have reduced premiums and out-of-pocket costs based on your income.
Or you may be eligible for a special health insurance enrollment period for your employer’s health plan. You can typically get health insurance only during an open enrollment period, but you can buy coverage at other times if you have a qualifying life event, such as losing coverage, getting married or having a baby.
“Some of the people who have incomes just above the Medicaid eligibility limit are likely to be eligible for subsidized private insurance through the health insurance marketplace, but others may become uninsured,” Lipton says.
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