It was in late January 2020 when a novel virus began sweeping the globe. With no tests or treatments available, COVID-19 was spreading rapidly in ways we did not yet fully understand. Against that backdrop, the U.S. Department of Health and Human Services declared a public health emergency. That declaration along with numerous other measures passed in the months that followed, paved the way for quite a few public health measures. Among them was increased Medicare flexibility, giving providers more leeway in determining how best to treat patients during the pandemic.
Today, COVID-19 remains a threat, but at nowhere near the same level, thanks to vaccines, testing and proven treatments. The World Health Organization (WHO) recently declared an end to the global public health emergency. And on May 11, 2023, the United States did the same. But what does this mean for Medicare recipients? What changed when the emergency declaration ended? Let’s investigate the specifics and find out exactly what you can expect.
Will Medicare cover COVID test kits after May 11th?
During the pandemic Medicare fully covered COVID lab tests. Eight free COVID-19 test kits for Medicare recipients were also available each month, at no cost to the recipient. This was true for those with Original Medicare (Part B) as well as Medicare Advantage. Now that the emergency declaration has ended, Original Medicare will no longer provide free home tests. If your doctor orders a lab test, you will be subject to your normal cost-sharing rules, just like any other lab test.
If you have Medicare Advantage, your plan may cover part or all of the cost of both home tests and lab tests. Talk to your plan provider for more information.
Who pays for COVID vaccinations and treatments?
Both Original Medicare and Medicare Advantage cover fully approved and recommended vaccines, from influenza (the flu shot) to tetanus. During the pandemic emergency, Medicare also covered vaccines that had received emergency use authorization (EUA). Both Moderna and Pfizer now offer fully approved COVID vaccines, which Medicare will continue to cover on the recommended dosing schedule.
Incidentally, if you are 65 or older or immunocompromised, and you got your booster dose of the updated vaccine more than four months ago, you are now eligible for a second booster. If you haven’t gotten the updated vaccine at all, you are eligible for one shot regardless of age or medical condition.
During the emergency declaration, oral antivirals such as Paxlovid, monoclonal antibodies and other COVID treatments were fully covered at no cost to the patient. With the end of the emergency, oral antivirals will be handled like any other medication. Medicare Part D, as well as some Medicare Advantage plans, may cover part or all of the cost. Your normal deductible and cost-sharing rules will apply. Original Medicare will continue to cover the cost of monoclonal antibodies through the end of 2024, at which time this treatment will likely revert to normal medication rules.
Does Medicare cover COVID-19 hospitalization?
Medicare covers all medically necessary hospitalizations subject to deductibles and cost-sharing. Following the ending of the pandemic emergency, COVID-19 hospitalizations will continue to be covered just like hospitalizations for any other illness or injury.
What happens to the FDA’s emergency use authorizations (EUAs) for COVID-19 products?
Not much. The public health emergency that is expiring is separate and distinct from the EUA declaration under section 564 of the Federal Food, Drug, and Cosmetic (FD&C) Act that authorizes the issuance of EUAs that pertain to a specific public health crisis. In March 2023, the Secretary of Health and Human Services issued a notice that a threat to public health and safety still exists, and thus the EUA declaration will continue. This means that all COVID-19 products currently available under EUAs will remain available for the foreseeable future.
What about telehealth and Medicare?
Medicare patient access to telehealth services was radically expanded during the COVID-19 pandemic. In essence, any patient can get telehealth services from any provider and pay only the same amount that they would for an in-person visit. This will remain in place through December 31, 2024.
After that time, however, telehealth availability will return to pre-pandemic rules. Those with Original Medicare must meet certain very specific criteria, such as being in a rural medical clinic or having end-stage kidney disease, to qualify for telehealth services. Some Medicare Advantage plans offer expanded telehealth benefits. Talk to your plan provider for more information.
How will Kansas begin eligibility redeterminations for Medicaid?
During the COVID-19 pandemic, the federal government incentivized states to keep continuous Medicaid coverage in place. This meant that instead of reviewing recipients’ eligibility annually, Kansas and other states simply provided continuous coverage for those who were previously found eligible for Medicaid.
Now, however, things are changing. The government funding bill that passed in December 2022, known as the Consolidated Appropriations Act (CAA) 2023, separated Medicaid eligibility from the COVID-19 pandemic. States now have until April 2024 to redetermine eligibility for all their Medicaid recipients.
This means that you will need to take proactive steps to maintain your Medicaid coverage if you still qualify. Although you should be contacted by the state, there are an estimated 536,000 people (more than 18% of the state’s total population) on either Medicaid or CHIP (the Children’s Health Insurance Program) in Kansas. It only makes sense to go ahead and contact your local Medicaid office for step-by-step instructions on what to do next.
If you lose your Medicaid eligibility, you do have options. Special enrollment periods will be available on the federal health insurance exchange for those who lose Medicaid eligibility. Or if you are on both Medicare and Medicaid, you may find that a Medicare Advantage plan meets your needs as you transition off Medicaid.
Do I still have access to take-home methadone for opioid use disorder treatment after May 11th?
If you are coping with opioid use disorder, you may be utilizing the take-home methadone program. During the pandemic emergency, treatment providers were eligible to authorize a certain number of take-home doses of methadone depending on exactly where the patient was in their treatment program:
As the pandemic emergency expires states must affirmatively register their concurrence with this exception to the traditional rules in order to keep providing the program. Check with your treatment provider for the latest Kansas guidelines.
Are COVID-19 lab results and immunization data still reported to the CDC after May 11th?
The Centers for Disease Control and Prevention (CDC) continues to track COVID-19 data but the tracking methods are changing. Rather than providing county-level test positivity, the CDC will track regional data through the long-standing National Respiratory and Enteric Virus Surveillance System (NREVSS). This collection of more than 450 labs also tracks other communicable diseases such as influenza and norovirus.
Hospitals must continue to report COVID-related emergency department visits and hospitalizations through April 2024. This data will be updated weekly rather than daily. COVID-19 deaths will also be reported weekly, and will now come from the National Vital Statistics System (NVSS).
Vaccine counts will still be available if local jurisdictions choose to report them. But they will now be updated on a monthly, rather than weekly, basis. The CDC will continue to conduct wastewater surveillance to identify potential outbreaks, as well as genomic surveillance to understand which variants are circulating.
Putting It All Together
The federal government has worked hard to provide a smooth exit ramp from the pandemic emergency to give both providers and patients a relatively easy transition. Things like extended telehealth provisions through the end of 2024 should help reduce the immediate impacts of ending the emergency declaration. And the extension of the EUA declaration ensures that vital tests and treatments will remain available. Although the emergency phase of COVID-19 has come to an end the virus remains a threat. It’s important to remain vigilant by continuing to get vaccinated, to test when you have symptoms and to seek treatment as soon as possible.
But there are some complications. Those who are currently on Medicare and those who participate in the take-home methadone program will want to reach out for guidance as soon as possible. If you have been relying on the free home tests for COVID-19 you will now have to pay out of pocket for them.
At Blue Cross and Blue Shield of Kansas, we understand that things may be confusing and that you might have a number of questions about how you will be affected. Our goal is to help clarify your understanding of your Medicare benefits and how they are changing. Please don’t hesitate to reach out with any questions you might have. Medicare Advantage members can call, 800-222-7645 and Medicare Supplement members can call 866-627-6705.
Whether you are looking for traditional health insurance or Medicare products, Blue Cross and Blue Shield of Kansas can help you take better care of your health. To learn more, give us a call today at 866-627-6705.