In January 2020, a public health emergency (PHE) was declared by the Secretary of the Department of Health and Human Services in response to the COVID-19 pandemic. Since that time, the PHE has been renewed several times (a PHE lasts for 90 days and must be renewed to continue), but expired on May 11, 2023.
So, what does the end of the PHE mean for you and your health coverage? With a return to pre-pandemic healthcare practices, it’s important for healthcare consumers to stay informed about regulations and policies that may impact their access to and coverage of services. As always, it is always best to understand and/or verify coverage and benefit limitations BEFORE receiving services.
Let’s take a look at a few specific areas that will be impacted by the end of the PHE:
Vaccine Distribution: The federal government played a significant role in distributing COVID-19 vaccines during the PHE. With this ending, coverage for the COVID-19 vaccine will likely move under a policyholder’s preventive benefit. This means that you would have zero out-of-pocket costs for the COVID vaccine, when administered by a provider in your network. If the vaccine was received at an out-of-network location, out-of-network charges would apply. Insurance companies will no longer be required to cover COVID vaccines from out-of-network providers at the in-network rate.
Testing and Treatment: The end of the PHE will result in changes to your availability and costs for COVID-19 testing and treatment. The requirement for insurance companies to cover COVID testing without cost sharing for members ends, as does the provision to provide up to 8 home test kits per month, per member. You will now have to pay your plan’s cost share for COVID related testing and treatment. And, just as with the vaccine, you will now also have to see a provider in your network for these services to be paid at in-network rates.
Telehealth Coverage: During the pandemic, many insurance companies expanded access or waived fees related to telehealth coverage to help patients receive care remotely. With the end of the PHE, this requirement for expanded access also ends, and can revert back to pre-pandemic coverage and costs. You should verify with your health plan provider to determine if there will be a change in coverage levels or cost share for your telehealth services. (Good news for PHP members! PHP has decided to keep this program in place and will continue to waive member’s cost share for using Parkview OnDemand, our telehealth service.)
Administrative Requirements and Extensions: Beyond specific provisions for COVID-related services, several other health coverage and enrollment requirements were also relaxed during the PHE to ensure as many people would have insurance coverage and access to healthcare services as possible. These areas include extending timeframes for filing claim appeals, enrolling in COBRA coverage, and mid-year plan enrollment due to qualifying life events. These programs do not end, rather the qualifications and time periods to participate will revert back to what they were pre-COVID, when the PHE ends.
The end of the PHE also has several impacts to those with Medicare and Medicaid coverage. The Department of Health and Human Services published this fact sheet with additional information on the transition away from this emergency phase for all types of coverage, as well as policy and reporting implications.
Remember, whenever you are seeking care (COVID related or otherwise), take these steps to ensure you are getting the most benefit from your health plan coverage:
- Verify doctors and facilities you use for services are in your plan’s network
- Choose the right level of care, like telehealth or office visits, instead of urgent care or emergency room, when care is not of an urgent nature
- Take advantage of preventive services that are included in your plan with no cost sharing
- Use online pricing and cost estimating tools before you receive services
Being prepared and informed before you schedule an appointment for services will ultimately save on out-of-pocket costs, help avoid potential claim issues, and make navigating the healthcare system a (somewhat) easier task.