End COVID-19 National and Public Health Emergencies on May 11, 2023
Per the 1/31/2023 Statement of Administration Policy by President Biden:
The COVID-19 national emergency and public health emergency (PHE) were declared by the Trump Administration in 2020. They are currently set to expire on March 1 and April 11, 2023, respectively. At present, the Biden Administration’s plan is to extend the emergency declarations to May 11, 2023, and then end both emergencies on that date. This wind-down would align with the Administration’s previous commitments to give at least 60 days’ notice prior to termination of the PHE.
These COVID-19 emergency declarations gave the federal government flexibility to waive or modify certain requirements in a range of areas, including in the Medicare, Medicaid, and Children’s Health Insurance (CHIP) Programs. The emergency declarations allowed for the authorization of medical countermeasures, and to provide liability immunity to providers who administer services in the private insurance arena. The public health emergency enabled the government to provide many Americans with COVID-19 tests, treatments and vaccines at no charge, as well as offer enhanced social safety net benefits.
Most Americans covered by Medicare, Medicaid, and private insurance plans have been able to obtain COVID-19 tests and vaccines at no cost during the pandemic. Those covered by Medicare and private insurance have been able to get up to eight at-home tests per month from retailers at no charge. Medicaid also picks up the cost of at-home tests, though coverage can vary by state. Those covered by Medicare and Medicaid have also had certain therapeutic treatments, such as monoclonal antibodies, fully covered. Once the emergency ends, Medicare beneficiaries generally will face out-of-pocket costs for at-home testing and all treatment. However, vaccines will continue to be covered at no member cost, as will testing ordered by a health care provider, for Medicare members.
COVID-19 vaccinations will continue to have no member cost for those with private insurance who go to in-network providers, even when the public health emergency ends. Going to an out-of-network provider could incur charges. Pfizer and Moderna have announced that the commercial prices of their COVID-19 vaccines will likely be between $82 and $130 per dose, which is about three to four times what the federal government has paid. Although there will not be a member cost for the vaccination if administered through an in-network provider, the cost will be incurred by the plan sponsor when the national and public health emergencies conclude.
During the COVID-19 national and public health emergencies:
- Medicare Advantage plans have been required to bill enrollees affected by the emergency and receiving care at out-of-network facilities the same as if they were at in-network facilities
- Additional funds were made available for hospitals, which have been receiving a 20% increase in Medicare’s payment rate for treating COVID-19 patients
- States were barred from kicking people off Medicaid in exchange for additional federal matching funds
The above practices will stop with the termination of the emergency declarations.
Note that the Telehealth flexibilities introduced during the pandemic have been extended through 2024, and will not change at the conclusion of the national and public health emergencies.
Note that the continuation of the COVID-19 emergency status until May 11, 2023 does not impose any restriction on individual conduct with regard to COVID-19:
- It does not impose mask mandates or vaccine mandates.
- It does not restrict school or business operations.
- It does not require the use of any medicines or tests in response to COVID-19 cases
More information can be found at:
https://www.whitehouse.gov/wp-content/uploads/2023/01/SAP-H.R.-382-H.J.-Res.-7.pdf