The Biden administration has announced that it plans to end the pandemic’s classification as a public health emergency on May 11, a move that will usher in a complex wave of policy changes that may complicate Americans’ testing and treatment options for the disease.
“The one word I have to describe this all is ‘confusion,’” said Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco. “It’s confusing already to know where to get a test, who’s paying for what, what’s my co-pay going to be. Now it’s going to be a complex equation.”
It’s not yet clear how the end of the public health emergency will play out, but here are health policy experts’ projections about how it could impact you.
If you have private insurance
The biggest change that most people will notice is that they will likely no longer be eligible for eight free at-home Covid tests each month through their insurance, said Jennifer Kates, a senior vice president at the Kaiser Family Foundation.
Dr. Kates recommended that people stock up on free tests that might be available at a local library or a Covid testing center before the emergency declaration ends — just make sure to note the expiration date. After that, people with private insurance will probably have to pay full price for at-home Covid tests at drugstores.
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They may also have new co-pays for treatments like Paxlovid and for P.C.R. tests, even those ordered by their doctor, Dr. Kates said. It is not yet clear just how expensive these co-pays will be, but they will likely be comparable to the costs of any prescriptions or tests recommended by a doctor, she said. Costs could vary from plan to plan, said Jose Francisco Figueroa, an assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health.
Paxlovid is tied to testing — people need to obtain a positive test to access the pill — and those combined costs could present an additional hurdle for some people, Dr. Chin-Hong said, especially since Paxlovid is most effective when taken within five days of the onset of symptoms. “With Covid, time is everything,” he said.
People with private insurance will not have to pay anything for Covid vaccines, whether they are being vaccinated for the first time or are receiving booster shots, as long as they obtain them from an in-network provider, Dr. Kates said. That is because of policy changes the Affordable Care Act introduced before the pandemic, she said.
If you are on Medicare
People on Medicare may have to pay co-pays for therapies like antivirals and tests ordered by a doctor, said Natalie Davis, a founder and the chief executive officer of United States of Care, a nonprofit that supports expanding access to health care. They will still be able to obtain free Covid vaccines, thanks to the CARES Act and regulations that the Centers for Medicare and Medicaid Services introduced during the pandemic, Dr. Kates said.
People on Medicare were previously able to receive eight free at-home Covid tests each month as well, she said, but they will no longer be able to do so and will likely have to pay the full cost of at-home tests.
If you are on Medicaid
People on Medicaid will be able to access Covid tests and treatments at no cost until 2024, Dr. Kates said, because of a provision in the American Rescue Plan. They will also be able to obtain free vaccines, thanks to a provision in the Inflation Reduction Act, she said.
If you are not insured
In some states, people without insurance have been able to obtain temporary Medicaid coverage for tests, treatments and vaccines, but that could also end after the public health emergency expires, Dr. Kates said.
Those without insurance are already struggling to access Covid care. “This is the group that falls through every crack in our system,” Ms. Davis said. These people will most likely need to rely on public health programs, which may vary depending on their location. “Different states will have different safety nets,” Dr. Chin-Hong said. “It’s going to end up being very regional.”
Ultimately, while health policy experts have raised concerns about the implications of the pandemic moving out of official “emergency” status, the wording may reinforce the mind set many people have embraced for months, if not years, said Dr. Paul Offit, a vaccine expert at the Children’s Hospital of Philadelphia.
“The American public already believes this pandemic is over,” he said.
