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The measures declared in The Covid-19 national and public health emergencies (PHE) have helped Americans get vaccinations and testing at no cost, while the funding behind these measures helped to make vaccination, testing, and treatment more accessible during the peak of the pandemic.
The public health emergencies have been renewed quite a few times over the past few years to continue coverage during the Covid-19 pandemic. However, the PHE will soon come to an end as Biden declared an end date in May 2023. The end of the PHE will affect all Americans including Medicare beneficiaries. Let’s take a look at what effects this will have on Medicare and how you can plan for any changes to come regarding your healthcare.
What are the Covid Public Health Emergencies?
The Covid Public Health Emergencies are a declaration of the determination that a public health emergency, in this case, the Covid-19 pandemic, exists. Under these declarations, certain measures were implemented as a result of the ongoing pandemic. The first Covid PHE was declared back in January 2020. Each of these declarations was set to expire on a specified date. However, the declaration has continued to be renewed due to the ongoing crisis surrounding the pandemic.
The measures under the PHE that most directly affect Medicare beneficiaries are those relating to vaccinations, testing, and treatment for Covid-19. The current declaration is set to end on May 11, 2023, meaning that the special coverage and funding for testing and vaccinations will end with the PHE.
How did they benefit Medicare beneficiaries?
The Covid Public Health Emergencies helped Medicare beneficiaries in several ways including:
- Covid-19 tests at no cost;
- Covid-19 vaccinations at no cost;
- Full coverage of certain therapeutic therapies such as monoclonal antibodies.
Testing for Medicare beneficiaries was covered by their medical insurance. This included testing at facilities as well as at-home testing. Under the measures of the PHE, Medicare beneficiaries were able to receive eight at-home tests per month from retailers without having to pay out-of-pocket.
The public health emergencies also provided other provisions for Medicare beneficiaries. These include:
- Additional funding for hospitals in the form of a 20% increase in Medicare’s payment rates to help in treating patients with Covid-19;
- The same billing for in-network facilities and out-of-network facilities for Medicare Advantage plan beneficiaries.
When will the changes take place?
The current Covid Public Health Emergency is set to expire on May 11th. Once the declaration expires, certain measures and provisions will expire with it. If you are looking to get the most from the measures while the PHE is still in effect, you can get your booster vaccinations before the end date and stock up on at-home tests while they are still covered fully by the PHE and Medicare.
Congress did extend one part of the government funding package under the PHE. One measure allowed all Medicare beneficiaries to enroll in telehealth during a public health emergency. Typically this flexibility was only an option for those living in rural areas. This measure will continue to allow Medicare beneficiaries to enroll in telehealth until 2024. By continuing this measure, beneficiaries will be able to get the healthcare they need without having to travel to an in-person facility for treatment.
What to expect as a Medicare beneficiary
Documents like the Covid Public Health Emergencies are often convoluted and difficult to interpret just how they will affect you personally. Luckily, you have a few months to plan and prepare for the expiration of the PHE. As a Medicare beneficiary, you can expect a few main things to change. Even with the pending expiration, you will still be able to get vaccinations and physician-ordered testing at no cost under your Medicare medical insurance. Medicare does cover vaccinations like the flu and Covid-19 regardless of the PHE which is very helpful considering Pfizer and Moderna are estimated to charge between $82-$130 per vaccination dose once the PHE ends.
In addition to the continued coverage of vaccinations and physician-ordered testing, Medicare beneficiaries will also continue to receive coverage of Paxlovid and other oral antiviral drugs created under emergency use authorization. Beneficiaries will no longer have other forms of testing like at-home testing covered by Medicare and will have to pay out-of-pocket for these services.
To sum it up
The Covid Public Health Emergencies is set to expire on May 11, 2023. When the PHE ends, Medicare beneficiaries will no longer receive at-home tests at no cost or coverage of certain therapeutic therapies related to Covid-19. Beneficiaries will continue to receive full coverage for boosters, vaccinations, and physician-ordered testing as well as coverage for oral antiviral drugs like Paxlovid created under the emergency-use authorization. While some things will change for beneficiaries, those with Medicare will continue to have access to telehealth until 2024 and receive coverage for vaccinations and certain testing.
