At-home (over-the-counter) tests may become more costly for people with insurance. The public health emergency required insurers to reimburse for up to eight antigen tests a person per month. After May 11, older Americans with traditional Medicare will no longer be able to get free, at-home tests. People with private insurance or Medicare Advantage (private Medicare managed-care plans) will no longer be guaranteed free at-home tests, but some insurers may continue to voluntarily cover them.
posted by mike kraft
on Thu, 2023-05-04 10:35
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As this long emergency period expires, experts say, the biggest impact for consumers will be the end of free coronavirus tests — both at-home tests and those performed by clinicians and analyzed by commercial labs — with broad implications for people’s ability to get timely covid diagnoses, prevent disease transmission and track the virus.
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Here’s how major health policies will be affected when the public health emergency ends.
For those on Medicaid, at-home tests will be covered at no cost through September 2024. After that date, home-test coverage will vary by state.
In addition, 18 states and U.S. territories have used their Medicaid programs temporarily to provide people who are uninsured free coronavirus testing services, including at-home tests, but that program will end with the public health emergency.
Although coronavirus tests ordered or administered by a health professional and analyzed by laboratories will still be covered for most insured people, these tests may no longer be free.
For people with traditional Medicare, there will be no cost for the test itself, but there could be cost-sharing for the associated doctor’s visit. For people with Medicare Advantage or private insurance, both the test and the associated doctor’s visit might be subject to cost-sharing, depending on the health plan....
People with Medicaid will continue to have access to free testing services through September 2024, after which point, states may limit the number of covered tests or impose nominal cost-sharing.
Uninsured people in the 18 states and territories that have adopted the temporary Medicaid coverage for them will no longer be able to obtain any type of free coronavirus testing services as this program ends with the public health emergency.
Vaccines will remain free for people with and without insurance. That is partly because the availability and costs of coronavirus vaccines, including boosters, are determined by the supply of federally purchased vaccines, not the public health emergency. So as long as federally purchased vaccines last, coronavirus vaccines will remain free to all people, regardless of insurance coverage. Providers of federally purchased vaccines are not allowed to charge patients or deny vaccines based on the recipient’s insurance status.
Even after the federal supply of vaccines is gone, which federal officials expect to happen in the fall, vaccines will continue to be free of charge to the vast majority of people with private and public insurance. Free coverage is required for all vaccines recommended by the CDC. For the uninsured, the Biden administration announced a $1.1 billion program to ensure access to free coronavirus vaccines and treatments through December 2024.
Medicare beneficiaries will not face cost-sharing requirements for certain covid pharmaceutical treatments, such as the antiviral Paxlovid, after May 11, as long as those doses were purchased by the federal government. Medicaid and the Children’s Health Insurance Program, meant for youngsters in working-class families, will continue to cover all pharmaceutical treatments with no-cost sharing through September 2024. After that, states may impose utilization limits and nominal cost-sharing. ...
Any pharmaceutical treatment doses purchased by the federal government will remain free to all, regardless of insurance coverage, based on availability. The United States has millions of doses of oral antivirals, such as Paxlovid, which are expected to last months. Once that stockpile is gone, the medications’ prices will be determined by the manufacturers. The price that individuals pay at the pharmacy will depend on their health insurance. ..
The Drug Enforcement Administration is extending public health emergency flexibilities for prescribing controlled medications via telemedicine. The agency has not determined how long the extension will last. During the emergency, providers writing prescriptions for controlled substances — such as the attention-deficit/hyperactivity disorder drug Adderall; the addictive painkiller OxyContin; the anti-anxiety medicine Xanax, and the opioid addiction treatment drug buprenorphine — were allowed to do so via telemedicine. The Biden administration had proposed new rules to take effect as soon as the emergency ends ....
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