What It Means for You

THREE YEARS AFTER Covid-19 was declared a public health emergency, most people’s lives have (mostly) gone back to normal.

Masks are rarely worn, about 80 percent of Americans have at least one Covid vaccine dose, and travel and other restrictions no longer exist—although people are still getting infected with the virus.

Now, President Joe Biden plans to end the Covid-19 national public health emergency (PHE) on May 11. The decision was announced in January to give individuals and healthcare providers enough time to prepare for the transition.

So what does the PHE ending mean for you? Health experts say it really depends.

“The kinds of things we should think about are, how do I get tested? How do I get vaccinated? How do I get access to antiviral agents like Paxlovid? And, of course, how do I receive basic medical care if I need it?” says Georges Benjamin, M.D., executive director of the American Public Health Association.

“The answer to all those questions depends on your insurance status,” he adds.

President Donald Trump declared the national PHE in March 2020 to combat Covid-19. The move made billions in federal funds available for the government to provide Covid tests, treatments, and vaccines at no cost, and created other benefits to lessen the impact.

“It’s a real problem that those funds will no longer be available,” especially if you don’t have insurance or if you’re on Medicaid, says Nancy Nielsen, M.D., Ph.D., senior associate dean for health policy at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences.

Here’s how the PHE ending will affect you and your ability to get Covid tests, vaccines, and treatments.

If You Have Private Insurance

People with private health insurance, through a workplace or health exchange, probably won’t notice any changes in their ability to access Covid vaccines, testing, or treatments.

Health plans will likely continue to cover Covid vaccines, but depending on the specifics of your insurance plan, you might have to pay some of the cost, according to the Centers for Medicare and Medicaid Services.

Testing via your healthcare provider will likely be covered, too, but you’ll likely have to pay for over-the-counter tests yourself. Covid treatments will be handled like other medications and therapies, where your deductible applies.

If You’re on Medicaid

Early in the pandemic, Congress passed legislation that provided enhanced federal funding to allow state Medicaid programs to keep people enrolled until the end of the Covid PHE, according to the Kaiser Family Foundation.

On April 1, states began reviewing their Medicaid enrollees’ eligibility, which varies by state. Many states are applying pre-pandemic eligibility requirements, which means many people will be found to be ineligible.

KFF estimates that 5 million to 14 million people could lose Medicaid coverage nationwide, leaving them uninsured.

If you’re on Medicaid, Dr. Benjamin suggests making sure your contact information is correct with your state Medicaid agency so that you’ll be notified if your coverage is ending.

Losing Medicaid will also mean you’ll no longer have coverage for other medications and care not related to Covid.

For people who remain on Medicaid, states are required to provide coverage for Covid testing, treatments, and vaccines through September 30, 2024, according to the U.S. Department of Health and Human Services. After that, coverage will vary by state.

If You’re Not Insured

“You’re on your own,” Dr. Nielsen says, if you don’t have health insurance because you lose Medicaid coverage or for another reason.

“If they want a test, if they want to see a physician, if they end up in the hospital, if they need drugs, they’re on their own to pay for it,” she adds.

The PHE ending brings the country back to its “normal system of delivery,” Dr. Benjamin says. “So, all the barriers that we had three years ago to getting health coverage, if you’re uninsured, will re-emerge.”

President Biden recently announced a $1 billion program to help the uninsured keep access to Covid treatments and vaccines at their local pharmacies and health centers.

Another thing to note: As long as the federal government maintains supplies of tests and vaccines, they’ll remain free to anyone.

If you find yourself uninsured, Dr. Benjamin recommends visiting your state’s Affordable Care Act health insurance marketplace to see what type of coverage you might be eligible for. In some cases, you might qualify for a reduced rate.

How the Health Emergency Ending Affects Covid Treatment, Testing, and Vaccines

Covid testing, vaccinations, and treatments have been available for free or low cost over the past three years. That may change for some people with the PHE ending. Here’s what you should know:

Covid Tests

Covid testing will likely be available at no cost to you, if you have health insurance and the test is provided via your health care provider, according to CMS.

Depending on your coverage, you could have a copay. And some insurance companies might only cover tests that have been ordered by a doctor. So, if you want one before a holiday gathering or a vacation, Dr. Benjamin says you’ll probably have to pay for it.

If you have Medicare, testing will still be covered if it’s ordered by your doctor.

“What won’t be covered is the over-the-counter test,” Dr. Nielsen says. “The home tests are the ones that people are probably going to have to start paying for.”

You can still order free at-home Covid tests from the federal government until they run out.

If you’re uninsured, you might be able to access a free test at a local public health clinic. Otherwise, you’ll have to pay for it.

Covid Vaccines

Like tests, vaccines will likely be covered if you have private insurance. You might have a copay, depending on your coverage.

Anyone can get a Covid vaccine for free (or very low cost) as long as the federal government’s supplies last. The Biden administration just announced a program to make the vaccine available to the uninsured, but the details haven’t been released yet.

Dr. Benjamin says free vaccines may also be available through local health clinics, so contact your local health department to find out what’s accessible in your area.

Costs for Covid vaccines might be $110 to $130 per dose, but insurance companies and the government could negotiate lower rates.

Covid Treatments

Many private insurers will continue to cover the Covid treatment Paxlovid. You might have a copayment, though, just like with other medications. Medicaid will cover treatments through September 2024.

The feds just announced a plan to devote $1 billion to ensure people who don’t have insurance will have access to Covid treatment, but the details haven’t been released.

Telehealth

The Covid PHE allowed for more flexibility for telehealth, which Dr. Nielsen says was a “wonderful thing.”

Many of these flexibilities—including accessing telehealth from any geographic area and staying in your home to receive telehealth—have been extended for Medicare and Medicaid recipients through 2024, according to CMS.

If you’re on private insurance, your continued access to telehealth will vary depending on your plan. You might have to get prior authorization from your physician or pay a copay to access it.

How to Prepare Yourself for the End of the Health Emergency

Worried about exactly what the PHE ending means for you? Dr. Nielsen and Dr. Benjamin have some advice:

• Contact your private insurance company to see what their policies will be for Covid testing, vaccines, and treatments
• Contact your state Medicaid agency, if you’re on Medicaid now, to find out when they’ll be conducting redeterminations—and, make sure they have your correct contact information
• Try to get insured—check your state’s health insurance exchange to find out what’s available if you don’t have insurance or will lose Medicaid coverage
• Keep up with Covid infection rates in your area
• Visit the websites for your local health department and community health clinics regularly to stay up-to-date on any free vaccine or testing clinics that pop up
• Find a primary care physician—even if you’re not insured, you can likely find a doctor who will provide care at a reduced rate
• Get vaccinated—and, all the boosters that might be encouraged in the future—to reduce your risk for infection and serious illness