The Public Health Emergency is Expiring on May 11, 2023
What does this mean for COVID-19 services for healthcare plan members?
By HCDI Communications
With the significant decrease in hospitalization, as more Americans are vaccinated against the COVID-19 virus, the country is in a much better place today than it was during the wake of the pandemic. The Public Health Emergency (PHE) is officially ending on May 11, 2023, as per the H.J.Res.7 law passed by President Biden in April.
What does this mean to us, whether we have Medicaid, Medicare, or private health insurance? Based on your healthcare plan, COVID-19 vaccinations, treatment, testing, and telehealth services may be impacted.
Here is a quick reference guide to understand the COVID-19 changes:
COVID-19 Vaccination
After May 11, 2023, COVID-19 vaccinations will remain at no cost to plan members.
| Medicaid and CHIP | Medicare | Medicare Advantage | Private Health Insurance |
| No cost until 9/30/2024 | No cost | No cost | No cost if in-network |
COVID-19 Testing
After May 11, 2023, COVID-19 testing costs will apply for over-the-counter tests. There is minimal to no cost for members who order tests through a health plan provider.
| Medicaid and CHIP | Medicare | Medicare Advantage | Private Health Insurance |
| No cost until 9/30/2024 | No cost | Cost may apply | No cost if in-network |
COVID-19 Treatment
After May 11, 2023, oral antivirals, such as Paxlovid and Lagevrio, used to treat COVID-19 will be free while supplies last. Once supplies are gone, plans may charge for these treatments.
| Medicaid and CHIP | Medicare | Medicare Advantage | Private Health Insurance |
| No cost until September 30, 2024 | Cost may apply | Cost may apply | Cost may apply |
Telehealth Services
After May 11, 2023, there are no changes to telehealth services for all plan members. After December 31, 2024, Medicare members’ access to telehealth services may change.
| Medicaid and CHIP | Medicare | Medicare Advantage | Private Health Insurance |
| No changes; policy varies from state-to-state | Provided to anyone in any geographic area in the US until 12/31/2024 by way of in-home or mobile device usage | Provided to anyone in any geographic area in the US until 12/31/2024 by way of in-home or mobile device usage | No changes; Cost and authorization may apply |
HHS Bridge Access Program For COVID-19 Vaccines and Treatments for Uninsured
In April 2023, HHS announced the Bridge Access Program for COVID-19 Vaccines and Treatments to maintain access to COVID-19 care for the uninsured. This will allow continued access to COVID-19 vaccinations, testing, and treatments for the uninsured at pharmacies and local health centers with minimal to no cost through December 31, 2024.
Unwinding Special Enrollment Period for Medicaid and CHIP is Underway
Due to the loss of continuous enrollment for many Medicaid and CHIP members, a temporary Special Enrollment Period (SEP) from March 31, 2023, to July 31, 2024, for qualified individuals and their families is available. Qualified individuals can submit a new application or update an existing HealthCare.gov application and have 60 days after application approval to select a coverage plan.
For more information on the PHE expiration and the COVID-19 plan changes, please visit www.CDC.gov.
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