© Reuters. FILE PHOTO: Paxlovid, Pfizer’s antiviral drug to treat the coronavirus disease (COVID-19), is shown in this illustration taken October 7, 2022. REUTERS/Wolfgang Rattay/Illustration
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By Ahmed Aboulenein
WASHINGTON (Reuters) – The U.S. government will end on May 11 the COVID-19 Public Health Emergency (PHE) that allowed millions of Americans to receive free vaccines, tests and treatment during the pandemic.
As the government moves into commercial channels, including private insurance and government health plans, most Americans, even those with health insurance, should expect some out-of-pocket costs for those products. Here’s who will pay for what and when:
COVERED AND UNINSURED
Hardest hit by the expiration of the PHE will be the more than 27 million uninsured Americans, mostly adults under the age of 65, who will lose access to free COVID tests, vaccines and treatments.
The uninsured rate hit a record low of 8% in early 2022, according to the latest available government data, but the US Department of Health and Human Services estimates that about another 15 million people, a third of them children, will lose their health coverage for the next year.
Congress had required state Medicaid programs to keep people enrolled continuously during the emergency. That ends on March 31, with a rest period that lasts until 2023, as outlined in the $1.66 trillion public spending “omnibus” bill that President Joe Biden signed on December 29.
Health officials say they are working on ways to help uninsured Americans with COVID-related costs, but have so far provided no details.
As it is, uninsured adults face paying full price for vaccines, which Pfizer/BioNTech SE and Modern (NASDAQ:) plans to quadruple from around $30 to $120 – tests and treatments, which can cost hundreds of dollars.
Limited supplies of vaccines and tests may be available at no or low cost through community health centers, and treatments will remain free while government supplies last.
IMMUNIZATIONS AND TESTS
Most Americans will still be able to get vaccinated at no cost. People enrolled in government or state health insurance programs like Medicare and Medicaid will still pay nothing, and those with private or employer-provided health plans should have no cost if they stay in-network.
Uninsured children will have access to free immunizations through the Vaccines for Children Program, but administrative fees may apply.
People with Medicare or private insurance will face out-of-pocket costs for over-the-counter home and laboratory COVID tests as soon as the emergency is over.
Those in the Medicaid or CHIP programs for poor adults and children will start bearing some of the costs in 2024, after which lab tests will remain free as long as they are ordered by a doctor. The cost of other testing services, including home testing, will vary by state.
COST OF TREATMENT AND COVERAGE
The US government has made COVID treatments like Pfizer (NYSE:) The oral antiviral Paxlovid is available for free at this time and will continue to do so while supplies last. After that, most people are expected to pay some out-of-pocket costs.
There are no laws on how private insurance should cover COVID treatments.
This means some out-of-pocket costs for treatments that insurers choose to cover, and potentially full prices for those that they don’t. It also means that people may be hit with higher insurance premiums if the costs of COVID treatment are substantial enough.
Medicare will continue to cover treatments, including those that receive Emergency Use Authorization (EUA) from the US Food and Drug Administration, but beneficiaries will still face some costs.
Medicaid and CHIP recipients will get FDA-approved treatments at no cost through the second half of 2024, but it will be up to individual state Medicaid programs whether or not to cover those under an EUA rather than full formal approval.
