How the end of the public health emergency (PHE) will affect your health coverage

The public health emergency (PHE) was first declared in January 2020, and has been extended every 90 days since then. Various laws and regulations related to health coverage have been tied to the PHE.

The national emergency was first declared in March 2020, and extended in one-year increments in 2021 and 2022. During the national emergency, deadlines related to COBRA and special enrollment periods for employer-sponsored health plans have been extended.

The Biden Administration has announced that both the public health emergency and the national emergency declaration will end on May 11, 2023.

The end of the PHE will not have an immediate impact on the COVID-related coverage that people receive via Medicaid:

• COVID vaccines will continue to be covered with no cost-sharing.
• Testing (including at-home tests) and treatment for COVID will continue to be covered with no cost-sharing until the summer of 2024 (through the end of the calendar quarter that begins one year after the PHE ends).

And although the end of the pandemic-related continuous coverage rules for Medicaid used to be linked to the end of the PHE, that’s no longer the case because the federal Consolidated Appropriations Act, 2023 decoupled the Medicaid continuous coverage rules from the PHE. Medicaid disenrollments have been paused nationwide since March 2020, but that rule ends March 31, 2023.

This means that states are returning to normal Medicaid eligibility redetermination processes, and people who are no longer eligible for Medicaid can be disenrolled as early as April 1. The start date for disenrollments will vary by state, and the eligibility redeterminations will be spread out over a 12-month period. So some enrollees who no longer meet the eligibility requirements will find that their coverage doesn’t end until late 2023 or early 2024. But again, this is no longer related to the end of the PHE.

For Medicare beneficiaries, the end of the PHE will bring some changes to how COVID-related coverage works, although the specifics will vary depending on how a beneficiary gets their coverage:

• Medicare will continue to cover COVID vaccines at no cost. COVID vaccines are covered under Medicare Part B, and the deductible and coinsurance do not apply. This is not linked to the PHE.
• Medicare has been covering COVID testing (including up to eight at-home tests per month) with no cost-sharing, and that requirement will end with the PHE. At that point, coverage and out-of-pocket costs will depend on whether the beneficiary has Original Medicare or Medicare Advantage:
  – Original Medicare will no longer cover the cost of at-home COVID tests. It will cover PCR testing under Medicare Part B, which does have a deductible ($226 in 2023) and then 20% coinsurance. If a beneficiary has supplemental coverage, it may pay some or all of the out-of-pocket costs for PCR testing.
  – If a beneficiary has Medicare Advantage, their plan may or may not cover the cost of at-home tests, and may or may not have cost-sharing associated with PCR testing. Beneficiaries will need to check with their plan to know what to expect.

• Out-of-pocket costs for COVID treatments after the end of the PHE will also depend on whether the beneficiary has Original Medicare or Medicare Advantage. Monoclonal antibody treatments will continue to be free for Medicare beneficiaries until the end of 2023. Other treatments will have varying costs, depending on whether they’re inpatient or outpatient, and the type of coverage that the beneficiary has.
• COVID-related telehealth flexibilities for Medicare beneficiaries will continue to be in effect through the end of 2024, and are no longer tied to the PHE timeframe (this is a result of the federal Consolidated Appropriations Act, 2023, which was enacted in late 2022).

For people with employer-sponsored health coverage, the end of the PHE will be similar to the effects for those with ACA marketplace coverage.

But the end of the national emergency will change the rules for COBRA deadlines and special enrollment periods for employer-sponsored plans, which aren’t applicable to those with marketplace coverage.

Here’s what you need to know about the end of the COVID emergency declarations if you have employer-sponsored health coverage:

• Recommended vaccines, including COVID vaccines, will continue to be covered with no out-of-pocket costs on all non-grandfathered employer-sponsored health plans (grandfathered plans do not have to cover any vaccines with zero cost-sharing; as of 2020, about 14% of covered workers were in grandfathered plans). But enrollees will need to use in-network providers in order to obtain zero-cost COVID vaccines.
• Employer-sponsored health plans will generally continue to cover PCR COVID testing administered by in-network providers. But regular cost-sharing (deductible, copay, coinsurance) can apply after the PHE ends, and plans will also be able to require a doctor’s order for the test.
• Just like other private health plans, employer-sponsored plans will no longer have to cover the cost of eight at-home COVID tests per month. Employer-sponsored plans will have the option to continue to provide some benefit for at-home test kits, but will not be required to do so (some employers may simply offer these tests directly to their employees; you can check with your employer to see if they have a plan for this). As is the case for people with marketplace coverage, those with employer-sponsored plans can continue to receive free at-home tests until the end of the PHE, and/or take advantage of the free tests that the government will mail to you while supplies last. Once at-home tests are no longer free, HSA or FSA funds can be used, pre-tax, to purchase them.
• The coverage of COVID treatment is unlikely to change. Medically necessary inpatient and outpatient care will continue to be covered, with the plan’s normal cost-sharing requirements.
• If you have a special enrollment right (an opportunity to enroll in your employer’s plan outside of open enrollment, due to a qualifying life event), you normally only have 30 days, or 60 days in some cases, to enroll. But that time-limited window has not been applicable during the national emergency. As of June 10, 2023 (60 days after the end of the national emergency), the time limits on special enrollment periods for employer-sponsored coverage will once again apply.
• Normally, you only have 60 days to elect COBRA (if it’s available to you), and then 45 days to pay the first premium. After that, you have a 30-day grace period for each monthly premium payment. But people have had up to a full year extension on these deadlines during the national emergency. That will end on June 10, 2023 as well, and the normal COBRA deadlines will once again be applicable.

In general, the take-away for most people is that vaccines will continue to be free as long as you use an in-network provider, testing will likely start to have cost-sharing associated with it, and cost-sharing for treatment will likely not change. COBRA and special enrollment periods for employer-sponsored health plans will continue to be available on the same terms as before, but their deadlines will once again be important, just as they were pre-COVID.