How does the end of the public health emergency from Covid-19 affect health insurance?

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The Covid-19 crisis has triggered a public health emergency, which has given the federal government the authority to waive and amend requirements for private health insurance plans, Medicare, Medicaid, and Children’s Health Insurance Program (CHIP).

During the public health emergency, patients and health policyholders have enjoyed 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 can affect out-of-pocket health care costs, health insurance coverage, and doctor visits.

What was the health emergency from Covid-19?

A public health emergency is an adverse event, such as a pandemic, that compromises the health of the population and can cause widespread disease.

The Department of Health and Human Services (HHS) declared a public health emergency in January 2020 due to the Covid outbreak. A public health emergency lasts 90 days unless renewed. The government has renewed the Covid-19 public health emergency several times over the past three years, including the most recent renewal earlier this year.

A public health emergency declaration allows 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.
  • Waiver of certain health insurance requirements.
  • Changing telehealth practices.

The emergency has allowed federal, state and local jurisdictions to take specific measures that they otherwise would not have been able to take, such as the creation of isolation and masking mandates, as well as the implementation of other measures intended to help us better protect the our population from this public health threat, says Peter Wood, vice president of planning and government affairs for community health in South Florida.

Why did the Covid-19 public health emergency end?

The Covid-19 public health emergency ended on May 11, 2023, largely due to the decrease in the Covid infection rate and the decrease in hospitalization and mortality rates.

The numbers have reached levels that the CDC and other federal government bodies have determined are manageable enough so that the public health emergency could be lifted and the nation could begin to return to normal, Wood says.

The Covid-19 public health emergency ended mainly due to fewer reported cases, hospitalizations and deaths.

How does the end of the public health emergency from Covid-19 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 be paying for Covid-19 tests, Covid-related medications and telehealth visits, depending on your health plan. Many people who were eligible for extended Medicaid or CHIP coverage due to 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 cost of Covid-19 vaccines received from an in-network provider. But your insurance plan may require you to share the cost if you are vaccinated by an out-of-network provider.

For insured patients, if your plan is a non-purchased plan, it must continue to cover vaccines for free, as they are considered preventive services under the Affordable Care Act, says Kim Buckey, vice president of customer services for Optavise, a provider employee of benefits 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 testing?

Your health insurance plan is no longer required to cover the costs of Covid-19 diagnostic tests, including over-the-counter tests and in-person tests. You may have to pay for all or part of these tests, 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 charge health plan members more of the costs through coinsurance deductibles and health insurance, or require prior authorization before tests are done, Buckey cautions.

He adds that most insurance companies will continue to cover lab tests for Covid, even if they don’t cover over-the-counter tests. They can limit the number of tests someone can get, require cost sharing, or charge for a doctor’s visit but not for 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 federally purchased pandemic-related drugs, such as Paxlovid and Lagevrio, with no need for cost sharing. regardless of your health plan.

You will likely have access to those drugs until the national supply runs out, even if the public health emergency is over.

How does it affect telehealth?

Covid has led to an increased reliance on telehealth appointments using smartphones, personal computers and tablets. Those with private or group health insurance may continue to qualify for low-cost or free telehealth visits with doctors, depending on their plan’s coverage.

Policies such as reimbursing providers at the same rate for telehealth and in-person services may have facilitated higher rates of telehealth use during the pandemic, says Brandy Lipton, an associate professor and applied microeconomist with expertise in health economics and public policy at the University of California, Irvine. But Lipton cautions that these policies could eventually change as the public health emergency ends.

If your group or private health insurance plan already had telehealth coverage, these benefits and what you pay will likely continue for the foreseeable future unless your plan changes the reimbursement rate for telehealth physicians.

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 maintained continuous enrollment of eligible beneficiaries through the end of the Covid-19 public health emergency. With the end of the emergency, the Kaiser Family Foundation estimates that between 5 million and 14 million people could lose eligibility for 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 allows you to compare health insurance plans available in your area and select a plan that may have reduced premiums and out-of-pocket expenses based on your income.

Or you may be eligible for a period of special health insurance membership for your employer’s health plan. Typically, you can only get health insurance during an open enrollment period, but you can purchase coverage at other times if you have an eligible life event, such as loss of coverage, marriage, or the birth of a child.

Some of the people who have incomes just above Medicaid’s eligibility limit are likely to be eligible for subsidized private insurance through the health insurance market, but others may not be insured, Lipton says.

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