Minneapolis, MN – Some of the health coverage and cost savings put in place during the COVID-19 pandemic are coming to an end. Medicareresources.org and healthinsurance.org are letting consumers know what changes to expect with the end of the public health emergency on May 11, 2023.
“Many people don’t realize their ability to access certain care at lower costs has been largely the result of the public health emergency,” said Dr. Tanya Feke, an analyst for medicareresources.org. “With the public health emergency coming to an end, it’s going to be an adjustment for consumers.”
The federal government expanded coverage for certain telehealth services, hospital care, and COVID-related testing and care under the public health emergency (PHE), beginning in January 2020. While some measures will continue or be phased out over the next few years, consumers will begin seeing changes to their coverage – and their share of costs – as early as May 12.
Expect changes in Medicare coverage
The end of the public health emergency will result in big changes for Medicare recipients, whether they have Original Medicare or a Medicare Advantage plan.
Changes to COVID-related Medicare benefits include:
- COVID tests: Unless at-home COVID tests are a supplemental benefit included in a Medicare Advantage plan, at-home COVID tests will no longer be covered with no out-of-pocket cost. Testing with an in-network provider will continue to be free under Original Medicare, but out-of-pocket costs for Medicare Advantage plan holders will depend on the plan.
- COVID-related care and medicine: Patients will become responsible for some costs – including any deductibles, copays, or coinsurance – for COVID-related visits and services that were free under the PHE. That also applies to some COVID-related medicines that were covered for free under the PHE. However, monoclonal antibody treatments for COVID will continue to be free for Medicare beneficiaries until the end of 2023; and oral antiviral medications for COVID will continue to be free through Dec. 31, 2024.
- Out-of-network hospital care: During the PHE, Medicare Advantage plans could not charge more for care received out of network, and physician referrals were not required. That will end June 10, 2023.
- Telehealth: Beginning May 11, coverage of audio-only telehealth visits will end, including for hospice care patients. The only exception is for mental and behavioral health services. Medicare will also return to a more limited list of telehealth technology platforms to better protect patient privacy.
“I expect these telehealth changes will be very disruptive,” Feke said. “The change in software use and audio-only access could result in a sharp drop-off in telehealth use overall.”
Marketplace and employer coverage is also changing
In general, Marketplace and employer-sponsored health plans already require their normal out-of-pocket costs for COVID treatments, and their telehealth coverage is not regulated to the extent that it is for Medicare. So the end of the PHE may not be as disruptive for consumers covered by these plans.
Here are the changes these consumers can expect:
- COVID tests: Plans will no longer be required to cover the full cost of at-home tests, so costs and coverage will start to vary by plan. Testing with a provider will likely start to cost consumers more as plans start covering this as they cover laboratory testing for other illnesses.
- COBRA coverage: During the national emergency, people leaving group health plans had more than a year to elect COBRA and pay their first premium. However, beginning June 9, 2023, COBRA deadlines will revert to 60 days to elect COBRA and then 45 days to pay the first premium.
- Employer-sponsored enrollment periods: Special enrollment periods for employer-sponsored health plans will once again be limited to 30 days, or in some cases 60 days. The limited enrollment windows were not applicable during the national emergency, but will return on June 9, 2023.
“Some of the normal rules didn’t apply during the pandemic,” said Louise Norris, health policy analyst for healthinsurance.org. “After three years, it will be a bit of an adjustment for consumers, who may face higher costs for things like COVID testing.”
Some coverage will stay the same
Even with the end of the PHE, consumers will continue to have access to free COVID-19 vaccines and boosters. That is true whether they have Original Medicare, a Medicare Advantage plan, a Marketplace plan, coverage through an employer, or Medicaid. (Grandfathered health plans, however, do not have to cover the full cost of vaccines). Consumers will need to comply with in-network restrictions to avoid costs, though.
Most consumers with a Marketplace plan or employer coverage will experience minimal or no changes to their telehealth access and coverage with the end of the PHE.
How the end of the PHE affects Medicaid
The end of the PHE will not have an immediate impact on Medicaid recipients. COVID vaccines will continue to be free under Medicaid. Testing and treatment for COVID will also continue to be covered by Medicaid at no cost, but only until the summer of 2024.
The PHE originally included a continuous coverage requirement that prevented states from disenrolling Medicaid patients. However, the federal spending bill passed in December of 2022 notified states that they could begin disenrollments as early as April 1, 2023. While no longer tied to the PHE, that policy change is significant as it is expected to result in the loss of Medicaid and Children’s Health Insurance (CHIP) coverage for up to 15 million people nationwide.
Medicareresources.org is one of the longest running online sources of in-depth information about Medicare. The site provides an overview of the basics of Medicare coverage options, enrollment and eligibility; coverage FAQs; state-specific Medicare information; and a glossary of Medicare terms. The medicareresources.org website is owned and operated by Healthinsurance.org, LLC.
Amy Fletcher Faircloth [email protected]