On April 11th, 2023 the federal government ended the COVID-19 Public Health Emergency (PHE). This signals the official end to many federal protections that were put in place to help the nation navigate the pandemic. There are implications for the coverage of COVID testing/treatment and Medicaid coverage with the expiration of the PHE.
Most carriers are continuing to cover the COVID-19 vaccination at no cost to the insured by adopting it as a part of their preventive benefits. However, you’ll want to make sure that you receive the vaccine from an in-network provider or pharmacy. If you use an out-of-network pharmacy or doctor’s office to receive this vaccination, you may be responsible for the full cost of the vaccination and administration charge.
As of April 11th, in-office COVID-19 tests and related expenses will be subject to the standard cost share benefits of your plan. Typically, the most appropriate test is the rapid or PCR test which only tests for COVID-19. To prevent unexpected expenses, avoid multiple or large panel tests. Surveillance testing is not a covered benefit, in-network or out-of-network. Additionally, telehealth visits related to the diagnosing of COVID-19 will be covered under the standard telehealth benefits of your plan.
Over-the-counter COVID-19 tests will also no longer be covered by most health plans, with the ending of the PHE. A person can use HSA or FSA funds to purchase these tests. The treatment of COVID-19, including approved medications, will be covered under your plan’s standard benefits.
Medicaid “unwinding” is another biproduct of the expiration of the COVID-19 PHE. During the period of March 2020 through March 2023 Medicaid did not disenroll members who were no longer Medicaid eligible with the intention of providing continuous coverage during the pandemic. Medicaid eligibility is based upon a number of factors such as income and resources. Nebraska Medicaid began their “unwinding” process on March 1, 2023 and it will continue over the next 14 months. If a person is no longer eligible for Medicaid they will receive a notice from Medicaid and information on how to obtain coverage through the Marketplace.
While COVID-19 will remain a part of our lives and healthcare, the end of the PHE signals a return to normal benefits and operations for our health carrier systems. This will align coverage and costs for COVID-19 with other similar services.
If you have questions regarding COVID-19 testing/treatment with ending of PHE or Medicaid unwinding process, our ComPro Team is here to help! Call 402-488-5100 to schedule an appointment. ComPro offers health insurance plans for Employee Benefits, Individual & Family and Medicare. They are your trusted and local resource for health insurance! For more info, visit www.comproins.com.
By Kayla Northup – Location Manager, MGA, Agent