The Public Health Emergency (PHE) for COVID-19 expired on May 11, 2023. The PHE allowed patients and healthcare providers to access COVID-19 vaccinations, testing, treatments, and services more easily during the pandemic. The end of the PHE will have changes that affect some healthcare costs and access to services. Here is a quick guide to what will, won’t, or could be changing now that the PHE has expired.
What WILL be affected:
Certain Medicare and Medicaid waivers
- During the COVID-19 PHE, a combination of emergency authority waivers, regulations, and regulatory guidance were used to expand access to care and to give health care providers the flexibilities needed to help keep people safe.
- Many of these waivers and flexibilities were necessary to expand hospital capacity to care for higher numbers of patients needing care during the pandemic.
- No longer necessary, many waivers related to increasing care capacity will end when the PHE expires.
3-Day Skilled Nursing Facility (SNF) waiver
- During the pandemic, Medicare temporarily waived the requirement for a 3-day prior hospitalization before covering the cost for a skilled nursing facility (SNF)
- After May 11, patients who get referred to a SNF without 3 days in the hospital will either be denied admission to the SNF or may be surprised by an unexpected bill when Medicare won't cover it.
- WellSpan has worked with our SNF Preferred Provider Network and independent practice partners to ensure awareness of the change regarding 3-day requirements for a covered admission.
Coverage for COVID-19 testing
- Medicare
- Medicare Part B beneficiaries will continue to have coverage without cost sharing for laboratory-conducted COVID-19 tests when ordered by a provider.
- Access to free over-the-counter (OTC) COVID-19 tests will end though, consistent with the statute on Medicare payment for OTC tests set by U.S. Congress.
- State Medicaid
- State Medicaid programs must provide coverage without cost sharing for COVID-19 testing until September 30, 2024.
- Private Insurance
- Private insurance companies are not required to cover tests without cost sharing for OTC or laboratory tests.
- However, coverage may continue if plans choose to continue to include it. If you are unsure if you have coverage for COVID-19 testing, please reach out to your insurance company.
Reporting of COVID-19 laboratory results and immunization data
- COVID-19 testing data reporting will not be required from labs.
- The CDC will stop producing the color-coded Community Level reports and maps of transmission rates.
What WON’T be affected:
Access to COVID-19 vaccinations and certain COVID-19 treatments
- Access to COVID-19 vaccinations and certain COVID-19 treatments will generally not be affected.
- The FDA’s Emergency Use Authorizations for COVID-19 products (including tests, vaccines, and treatments) will not be affected.
Out-of-pocket expenses for COVID-19 vaccinations
- Out-of-pocket expenses for COVID-19 vaccinations will not be affected for most patients.
- Most patients will continue to pay nothing out-of-pocket for the COVID-19 vaccine. Most private insurance plans will continue to fully cover vaccines without a co-pay as a preventive health service.
- COVID-19 vaccinations are covered under Medicare Part B without cost sharing, and this will continue.
- Medicaid will continue to cover all COVID-19 vaccinations without a co-pay or cost sharing through September 30, 2024.
Telehealth (video visits) through Medicare
- Individuals with Medicare can continue to see providers virtually using telehealth.
- Coverage for most Medicare telehealth services will remain in place through December 2024.
Telehealth (video visits) through Medicaid
- Individuals with Medicaid can continue to see providers virtually using telehealth.
- States already had significant flexibility with respect to covering and paying for Medicaid services delivered via telehealth prior to the COVID-19 PHE and will continue to be available after the COVID-19 PHE ends.
What MAY be affected:
Out-of-pocket expenses for certain COVID-19 treatments
- Out-of-pocket expenses for certain COVID-19 treatments may change, depending on an individual’s insurance coverage.
- Changes would be similar to costs that one may experience for other drugs. Talk with your pharmacy for exact out-of-pocket expenses associated with COVID-19 treatments (i.e. Paxlovid).
Telehealth (video visits) prescribing of controlled substances
- On May 3, the Drug Enforcement Administration (DEA) announced a temporary extension of PHE flexibilities allowing providers to prescribe controlled substances via telehealth until further notice.
- This allowed for some prescribing of controlled substances, such as buprenorphine, to patients without an in-person interaction.
- While this has been extended, the prescription of controlled substances via telehealth may change. Please continue to check back as any new rules are announced.
