What happens when the COVID-19 emergency declaration ends? Prepare for big changes in your health insurance and medical expenses (2023)

National and public health emergencies related to COVID-19 arescheduled to end on May 11, and the change will take a financial toll on Americans as they continue to grapple with the virus in their daily lives.

The emergency declarations, first issued in early 2020 when the pandemic took hold, triggered a series of government measures aimed at reducing costs for both individual consumers and hospitals.

The declarations "gave the federal government the flexibility to waive or change certain requirements in several areas, including Medicare, Medicaid, and CHIP [Children's Health Insurance Program] programs, as well as private health insurance."KFF researchers wrote, a nonpartisan health think tank, in a brief overview of the implications of ending statements.

Some of the legislation that Congress passed in response to the statements - including theFamilien First Coronavirus Response Act; To dieCARES-Gesetz (Help, Relief and Economic Security with the Coronavirus).; it's atamerican bailout law— Obligation of health insurerscover the cost of COVID testing, so there is no cost to consumers to get tested. (Many health insurers also voluntarily covered the costs of treating COVID-19 early in the pandemic, butstopped doing thatby the end of 2020.)

The end of emergency declarations also means that the government will no longer directly manage the development of vaccines and treatments, a move that is expected to lead to higher vaccine prices.informou a Associated Press.

What does all this mean for American wallets?

More people will likely have to pay for COVID testing, but how much is left for insurers

More people are likely to have to pay for COVID testing that would otherwise be free. "This is where you will really start to see the changes," said Cynthia Cox, vice president of KFF. These days, people pay to get a COVID test in rare situations, she said — like when they have to get a weekly test for work.

National health insurers for COVID-related emergencies have limited the ability to charge for the tests, but when that's over, it's up to insurers to set the rates, and insurers can also charge patients for related doctor visits.

Insurers may introduce new restrictions, e.g. B. asking them to find an in-network provider, increasing the copayment, limiting the number of COVID tests they cover during a given period, or even discontinuing the free take-home test kits that some health insurance providers charge monthly .

Currently, most Medicare and private health insurance customers can get up to eight free take-home test kits per month, Cox added.

Millions of people could lose Medicaid coverage

As many as 18 million people could lose Medicaid health coverage when the national COVID-19 emergency ends, according to a recent analysis by the Robert Wood Johnson Foundation, a nonprofit organization based in Princeton, New Jersey, that focuses on public health. While many people currently enrolled in Medicaid will transition to other insurance options, an estimated 3.8 million people will be completely uninsured. Uninsured rates will rise 20% in 19 states, the foundation added.

“The Families First Coronavirus Response Act's ongoing coverage requirement prevents state Medicaid agencies from enrolling people during the COVID-19 public health emergency. However, when the emergency declaration expires – currently scheduled for April 2023 – states will resume normal eligibility rules.”said the organizationIn December. "This could result in millions losing access to affordable health insurance through Medicaid."

“State Medicaid officials and policymakers must continue to ensure that individuals currently enrolled in Medicaid are aware of the near end of the public health emergency and that they have a plan to maintain new health coverage through their employer, the federal health or to find. or Medicaid," she added.

Potential new co-payments for COVID treatments

For those with private insurance, the end of the public health emergency won't change much about what they are already paying for COVID-related treatments and medications. But there may be a new cost-sharing for COVID treatments in Medicare.

There may also be a transition period where some providers charge for COVID-related drugs while others don't, Cox said, as the federal government purchased some drugs for COVID-related treatment during the pandemic, including the oral antiviral Paxlovid. by Pfizer. The government bought Paxlovid at a reduced price of $530 per treatment cycle, but that's itOn the free market they must cost a lot more.

If the drug came from the federal government, it would still be free, but consumers would be able to pay for hospitalization and other services. If the drug was purchased from a private supplier, the patient would have to pay for it.

Individuals covered by Medicare Part Dmay see their treatment costs rising, because the insurance program does not cover drugs that are not fully approved by the Food and Drug Administration. Paxlovid is currently available under an emergency authorization. Emergency Use Authorizations allow the FDA to release treatments to the public more quickly, typically when there is a public health emergency such as a pandemic or bioterrorism attack.

Easy access to telemedicine services may end for some people, forcing them to incur more costs for a doctor's appointment.

Expanded telemedicine coverage during the public health emergency has enabled millions of people to remotely access health services. While most of this expanded coverage has been extended through the end of 2024 or, in some cases, made permanent, the end of the public health emergency could affect the availability of out-of-state services through telemedicine for some patients.

But a relatively small number of patients will be affected, such as people who need to see a specialist in another state, Cox said.

Hits people with weakened immune systems and low-income private policyholders particularly hard

The cost of COVID testing and treatment adds up quickly and can be difficult to cover for low-income people who have private health insurance, Cox said.

The same is true for people who are particularly vulnerable to severe outcomes from COVID-19, she added. The relaxed COVID restrictions may pose the greatest risk to people with underlying health conditions, as well as those who have compromised immune systems due to medical issues or immunosuppressant medications. More than most, they rely on their friends and family to get tested frequently for COVID-19.

“This is one of the last layers of protection being lifted for them,” Cox said.

As long as vaccines purchased by the federal government last, they are free for people without insurance.

One thing that won't change immediately once the public health emergency is over is that uninsured adults will continue to have access to free COVID-19 vaccines and boosters. The federal government has already paid for all vaccines and booster shots currently being administered, and providers have agreed not to charge for these vaccines.

However, once sold out, manufacturers will charge for these vaccines. For example, Pfizer announced that theCommercial price of your COVID-19 vaccinesit will likely be $110 to $130 per dose, which is about three times what the federal government has been paying. The recordings are expected to be commercially available in the first quarter of next year.

Children without insurance continue to have access to vaccinesof Vaccines for Children (VFC)-Programhowever, after the purchased supply across the country is exhausted, suppliers may charge an administration fee, KFF says.

COVID vaccines and boosters "will continue to be freely available to virtually all individuals with public and private insurance, even in the absence of federally procured supplies or protection for [public health emergencies]."alto KFF. "Most privately insured individuals will continue to pay nothing out of pocket for COVID-19 vaccines/boosters, but there will be exceptions (e.g., supplies have run out)."

It's hard to predict when government-funded vaccines will run out, Cox said, but it won't be anytime soon -- at least not until May 11, when the emergency declaration ends.

See too: What an end to the government's COVID emergency could cost you

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