How Ending the COVID-19 Public Health Emergency Affects Medicare

Over three years ago, the federal government declared a public health emergency (PHE) with the rise of COVID-19. This was important so funding could be allocated toward helping get treatments, tests and vaccines to as many Americans as possible.

As of May 11, 2023, the PHE has ended, and that can affect different parts of people’s lives, from how they pay for testing and treatment to programs that helped facilitate easier access to health care.

How does the end of the COVID-19 PHE affect you as a Medicare recipient? Let’s get into some details and find out how you can adjust after the transition. (Hint: It’s simpler than you think!)

COVID-19 PHE Programs

During the COVID-19 PHE, the government was able to create and fund measures that helped slow the spread of infections and promote overall public health. These included:

• Free COVID-19 testing, regardless of one’s health insurance status
• Quicker access to care by removing some barriers to treatment through emergency waivers
• Increased access to telehealth resources for those living in rural areas
• Allowing more people to continue their Medicaid coverage without a lengthy requalification process
• Simpler access to some pain and addiction medicines when a provider could not be seen in person

Many of us were able to benefit from these programs. If you’ve had a drive-up COVID-19 test, got a new prescription over a video call or received free hospital care during a COVID-19 infection, it was because of the PHE provisions.

The PHE ended on May 11, 2023 — what does that mean for you? Let’s look at what has changed and what has not.

What Happens to Medicare Enrollees After the End of the Public Health Emergency?

For many people enrolled in Medicare, not a whole lot has changed. But there have been adjustments to how routine services are paid for and accessed. Let’s start with what did not change on May 11th and then go over what has changed.

For those with Medicare coverage, here’s everything you need to know!

PHE Benefits That Remain After May 11th

1. Vaccines: You still have access to COVID-19 vaccinations without cost sharing after the end of the PHE.
2. Testing: Original Medicare participants do not have to pay for COVID-19 PCR and antigen tests when the test is ordered by a doctor or health care provider. Those with Medicare Advantage may need to pay for all COVID-19 tests — check with your plan.
3. Treatments: There are no changes to how Medicare covers treatments for those exposed to COVID-19, including maintaining the same cost sharing as before.
4. Telehealth: All individuals with Medicare continue to have access to telehealth services until December 31, 2024, without geographic or location limits that had previously applied before the PHE began. Check with your individual plan for information about this coverage and what may change after the end of 2024.
5. Access to buprenorphine for opioid use disorder treatment in Opioid Treatment Programs is not affected. Patients are allowed to begin this treatment over telehealth rather than a required in-person visit, and this change is currently expected to stay.
6. Expanded access to in-home methadone doses for opioid use disorder treatment is extended until May 11, 2024.

PHE Benefits That Ended on May 11th

As of May 11, some benefits and service-related waivers that were specific to the public health emergency ended. These include:

1. Reimbursement for over-the-counter COVID-19 testing kits by one’s health plan
2. Other COVID-19 tests may no longer be covered if they were not ordered by a health care provider
3. Waivers that allowed acute care patients to be housed in facilities other than a hospital — this waiver was intended to free up more hospital space if needed
4. Waivers that allowed certain hospitals to increase their number of beds available for critical patients
5. The return of the three-day required inpatient hospital stay for Medicare coverage of a skilled nursing facility stay — the waiver that bypassed this requirement has ended

PHE Benefits and Your Medicare Coverage

You might have noticed that not a lot changed for you after May 11th — this is great! The biggest change that affects everyone is that you now need to pay for over-the-counter COVID-19 tests, but it may be a minor impact in your daily life.

Conclusion

Medicare coverage has stayed the same for most Americans after the end of the COVID-19 public health emergency. You still have access to expanded telehealth until the end of 2024, and a few rules around hospital stays has changed. Find out more by reading the full documentation on the government’s CMS website: https://www.cms.gov/newsroom/fact-sheets/cms-waivers-flexibilities-and-transition-forward-covid-19-public-health-emergency

If you have any questions about Medicare or Medicaid coverage, please feel free to give us a call. One of our PlanEnroll agents will be happy to help you. Call us to speak with a licensed insurance agent today.

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