What Ending the COVID-19 Public Health Emergency Means for Your Pocket

A lab technician works in the Emergency Department at Providence St. Mary Medical Center in Apple Valley, Calif., on March 11, 2022. (Mario Tama/Getty Images)

The Biden administration will be ending the COVID-19 public health emergency and national emergency declarations within several months, with a range of impacts on Americans and their pocketbooks.

Under the dual emergency declarations, most Americans have had access to free COVID-19 tests, treatments, and vaccines—even if they’re uninsured. But that’s about to change.

Amid Republican pressure to end the twin emergencies, the White House announced in a Jan. 30 policy statement (pdf) that it will be terminating the declarations on May 11, 2023.

Initially, the national emergency was slated to expire on March 1 and the public health emergency was set to run out on April 11, with Republicans pushing for no further extensions.

Some two dozen Republican governors in December asked President Joe Biden to end the COVID-19 public health emergency in April (pdf), arguing that it was inflating the population covered under Medicaid and costing states hundreds of millions of dollars.

In November, 13 Senate Democrats sided with Republicans to approve a resolution that would terminate the national emergency. However, President Joe Biden opposed it and said he'd veto it if the measure reached his desk.

In the Jan. 30 policy note, the White House justified the extension of the twin declarations through May 11, arguing that an “abrupt end to the emergency declarations would create wide-ranging chaos and uncertainty” for health systems and ordinary Americans.

Regardless, the end of the emergency orders is fast approaching, with a range of implications for Americans.

Most Americans—even those with health insurance—can expect some out-of-pocket costs for COVID-19 services like tests, treatments, and vaccines once the twin declarations end and the government hands things off to the private sector.

Vaccines

Most Americans will still be able to get COVID-19 vaccines and boosters at no cost.

As long as the public health emergency is in effect, private health plans and insurers are required to cover COVID-19 vaccines without cost sharing even if provided by out-of-network providers.

After May 11, people with private health insurance will continue to be offered the shots for free but only if they get them through in-network providers.

“Participants may have out-of-pocket costs if they receive a COVID-19 vaccine from an out-of-network provider,” a legal team at Winston & Strawn LLP, a law firm, said in a note.

People enrolled in government or state health insurance programs such as Medicare and Medicaid will continue to pay nothing for vaccines.

Uninsured adults will no longer be able to get free vaccines, which under the emergency order were covered through state Medicaid programs, according to KFF.

Children who are uninsured will continue to have access to free vaccines through the Vaccines for Children Program, though they may face some administrative fees.

A nurse administers the Pfizer booster shot at a COVID-19 vaccination and testing site at Ted Watkins Park in Los Angeles, Calif., on May 5, 2022. (Frederic J. Brown/AFP via Getty Images)

Tests

Under the emergency declarations, people on private health insurance plans or Medicare could get up to eight rapid at-home COVID-19 tests per month for free.

Once the emergency ends, people on Medicare will face out-of-pocket costs for both laboratory and at-home over-the-counter COVID-19 tests.

Those on private health plans may continue to receive free tests but only if they’re distributed by in-network providers.

“Participants may incur out-of-pocket costs for COVID-19 diagnostic tests and testing-related services,” the Winston & Strawn LLP legal team said.

People on Medicaid or CHIP programs will continue to have their COVID-19 tests paid for but only until the last day of the first calendar quarter beginning one year after the public health emergency ends, according to KFF.

This means that, until the second half of 2024, people on Medicaid or CHIP will start to see some out-of-pocket expenses, but lab tests will continue to be free of charge if ordered by a doctor.

For those on Medicaid or CHIP, the cost of other testing services, including at-home tests, will vary by state after the 2024 deadline.

Take-home COVID-19 self-testing kits provided by the District of Columbia government, in a photo illustration taken on Jan. 11, 2022. (Evelyn Hockstein/Reuters)

Treatments

Americans with private health insurance will continue to be covered for COVID-19 treatments, including such antiviral therapies like Paxlovid, as long as their plans offer such coverage.

“There is no federal mandate requiring group health plans to cover treatment of COVID-19. Most private plans currently require some form of cost sharing,” the Winston & Strawn LLP legal team said.

At the same time, the U.S. government has made treatments like Paxlovid available for free and will continue to do so while supplies last. But after those run out, people on private health insurance are likely to have to pay some out-of-pocket costs, per the details of their plans.

“There are currently resources outside private plans that provide free COVID-19 treatment, such as antiviral medications,” the Winston & Strawn LLP legal team said. “Once the Public Health Emergency ends, these resources may no longer be available or may be more limited, which may affect plan costs.”

Insurers may decide to cover some treatment costs but if not, people may have to pay full prices. People might also face higher insurance premiums if the COVID-19 treatment costs are high enough.

As for those on Medicare, they'll be covered for antiviral treatments as long as the federal supply lasts. But after those doses run out, people on Medicare will have to pay some out-of-pocket cost for treatments.

People on Medicaid and CHIP programs will be eligible to receive FDA-approved COVID-19 treatments at zero cost until the second half of 2024. However, it will be up to individual state Medicaid programs whether or not to cover those under an EUA rather than full formal approval.

Coverage

The emergency declarations gave the federal government the ability to modify requirements in programs like Medicare and Medicaid, as well as private health insurance plans.

In particular, the public health emergency barred states from disenrolling people from Medicaid. This drove nearly 20 million people to enroll in the program during the COVID-19 public health emergency, around 30 percent above pre-pandemic levels.

As part of the omnibus spending bill that was signed into law on Dec. 29, 2022, the continuous enrollment provision ends on March 31.

KFF estimates that—in the year after the Medicaid disenrollment rule ends at the end of March—between 5 million and 14 million people will lose Medicaid coverage.

Reuters contributed to this report.