As the Covid-19 National Emergency and Public Health Emergency both come to an end, it is important to understand the implications of this transition for individuals seeking healthcare services. While the end of the National Emergency may signal a return to normalcy for many aspects of life, it is essential to be aware that the primary changes happening right now are directly related to who is paying ($) for the pandemic. 

Overall, the end of the Covid-19 emergency declarations will result in higher costs for Covid tests and treatment, changes in health policies, and potential loss of healthcare coverage for millions of people. It's important for individuals to stay informed about these changes and their potential impacts on access to healthcare. In this article we will discuss what changes you need to be aware of, what to expect in regards to testing, treatment, vaccinations, telehealth, and healthcare coverage, as well as ways to save money on these preventative, diagnostic, and treatment options. 

The declarations allowed “a public health approach to health care during the pandemic,” says Dr. Josh Sharfstein, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health. “They helped a lot of people to get services. Now we’re going back to a health care approach to health care, and that brings all of the weaknesses of our system into play.”

Please note: like the rest of the pandemics public health information, much of this is still incredibly vague and may change at any point. We have linked sources at the end of this article and will update as things evolve.   

What you need to know

In this section, we will discuss the implications of the termination of emergency declarations on the cost of healthcare. As millions of individuals may find themselves without coverage or struggling to afford necessary care, the government and insurance companies appear to be shifting the burden directly onto patients. This alarming trend is anticipated to have severe consequences, including an increase in mortality rates, mounting medical debt, and elevated out-of-pocket expenses for those seeking treatment.

As we transition into the new normal, we are returning mostly to our fragmented health system as we knew it.

Jen Kates, director of global health at the Kaiser Family Foundation, said in an interview with Vox. 

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I. How does the end of the COVID-19 Emergency Declarations impact testing?

During the pandemic, widespread testing was implemented to detect and prevent the spread of Covid-19. However, with the end of the emergency, testing requirements and availability are expected to change, affecting access to testing for individuals who may still need it for various reasons. Testing is still an incredibly valuable tool at a national level to keep a close eye on the spread of COVID-19 and to minimize the spread of the virus. On an individual level, a positive test for SARS-CoV-2 is necessary to access early treatment, sick leave, and support in the case of developing Long Covid or related post-viral complications. 

• With insurance: The requirement for private insurance companies to cover COVID-19 tests without cost sharing, both for OTC and laboratory tests, will end. However, coverage may continue if plans choose to continue to include it. The test and the associated doctor’s visit both might be subject to cost-sharing, depending on the plan. Additionally, some insurers might begin to limit the number of covered tests or require tests be done by in-network providers.
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• Medicare: Medicare beneficiaries who are enrolled in Part B will continue to have coverage without cost sharing for laboratory-conducted COVID-19 tests when ordered by a provider, but their current access to free (OTC) COVID-19 tests will end. While the test may remain free for the time being, patients should be aware that there could be cost-sharing for the associated doctor’s visit.
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• Medicaid: For people with Medicaid, testing will remain free until (at least) September 30, 2024.
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• Uninsured: Most uninsured people in the United States have been responsible for paying for their own Covid testing for the majority of the pandemic. Some states have adopted a temporary Medicaid coverage option which covered testing for free, however these programs will all expire with the public health emergency.

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How much does a Covid-19 test cost? 

Similar to most of healthcare expenses, this is not an easy answer and carry vary widely in price. An investigation by the Kaiser Family Foundation determined that the cost of a test can range anywhere from $20 to $850, with $127 being the median cost. Currently, the Medicare reimbursement rate for a COVID-19 test is either $51 or $100, depending on the type of test offered. For those who end up paying out of pocket, there was a smaller range of $36 to $180 per test. Again, any test would also likely require additional charges for specimen collection and a physician’s visit, which could potentially add to the cost significantly.

‍If you’re looking to stock up on rapid at-home tests: Wired has a great breakdown of test options and price overview.

How to save money on testing:
• Free at-home covid tests (4/household/month) through May 11, 2023
• Insurance reimbursements (8/month/person) through May 11, 2023. Some plans may continue reimbursements, so check with your insurance company.
• Search for No-Cost COVID-19 Testing​. Available (at least) through May 11, 2023.
• Certain cities and states may continue to support free covid testing, though it is not clear until when. For example: LA County offers guidance on free and low-cost testing options.
• If your employer or school is requesting a Covid test: ask them about resources they have available to offer tests at no cost to you.
• ​​Many pharmacies offer free COVID-19 tests. Visit their website or call to check if they require an appointment or charge fees.
• Other places that may offer free testing: county-run facilities, local libraries, community centers such as: food banks, senior centers, and other local organizations may offer free test kits for pick-up.

II. How does the end of the COVID-19 Emergency Declarations impact vaccinations? 

Thanks to the Affordable Care Act, America’s overall “vaxxed and relaxed” pandemic strategy, and other recent legislation, coverage for vaccines will remain relatively unchanged even after the end of the emergency declarations and will continue until we have depleted the federally purchased vaccine supply. Even after the federal supply of vaccines is gone, vaccines will continue to be free of charge to the vast majority of people with private and public insurance.

What to expect?

“As long as federally purchased vaccines last, COVID-19 vaccines will remain free to all people, regardless of insurance coverage. Providers of federally purchased vaccines are not allowed to charge patients or deny vaccines based on the recipient’s coverage or network status.” [Source]

• With insurance: Many plans must continue to cover COVID-19 vaccines at no cost to employees from an in-network provider. However, the requirement to cover COVID-19 vaccines out-of-network will generally lapse after the end of the COVID-19 public health emergency.
• Medicare: Currently, COVID-19 vaccinations are covered under Medicare Part B without cost sharing, and this will continue for the foreseeable future.
• Medicaid: Vaccinations will remain free for the foreseeable future. Required to cover all recommended vaccines at zero cost to the patient.
• Uninsured: Uninsured adults won’t have to pay for Covid shots purchased by the federal government, because there are still doses in the federal supply. But once those doses run out, they will most likely be charged. Children without insurance will still be eligible for free Covid shots through the Centers for Disease Control and Prevention’s Vaccines for Children Program. Their families may be charged for the office visits, however.

*insert commentary from Moderna and Pfizer regarding expected costs moving forward* 

How to save money on vaccinations: The federal supply of Covid-19 vaccines are expected to last until Summer/Fall 2023 and will remain free for all Americans. To find information on where to get COVID-19 Vaccines and boosters near you, check out the CDC vaccination locator. 

III. How does the end of the COVID-19 Emergency Declarations impact the cost of treatment?

Early treatment remains a key part of reducing severity, hospitalizations, and death for those infected with COVID-19. Patients will continue to be responsible to costs associated with hospitalizations, ER Visits, out-patient visits, and treatments not purchased by the federal government.

What to expect? 

Any pharmaceutical treatment doses (e.g. Paxlovid) purchased by the federal government are still free to all, regardless of insurance coverage, until the federal supply has been depleted. Most people have been responsible for a large portion of cost-sharing related to COVID-19 treatment (82% on average, since 2021), so there are not new major changes tied to the end of the emergency declarations. 

  • With insurance: Private insurers were never required to waive cost-sharing for any COVID treatment so patients should not expect major changes here and are responsible for the same cost-sharing as any other medical treatment. 
  • Medicare: People with Medicare Part D, can get Paxlovid free through December 2024.
  • Medicaid: Medicaid and CHIP programs will continue to cover COVID-19 pharmaceutical treatments without cost sharing through September 30, 2024
  • Uninsured:  "Unless it’s a federally purchased vaccine or treatment or test, the uninsured do not have any guarantee for coverage," Kates said.

How much does a Covid-19 treatment cost? 

The cost of treatment for COVID-19 varies widely based on a multitude of factors, including: insurance coverage, income, severity, treatment options, and geographic locations. Additionally, little work has been done at getting a realistic picture of what patients are actually paying for COVID treatment and most studies reflect numbers based on 2020 costs, when many insurance companies were still waiving cost-sharing. 

It is clear that price transparency still has a long way to go and that additional resources need to be allocated to studying the financial impact that COVID-19 continues to have on patients across the country. We have done our best to compile average out-of-pocket costs for insured patients

In addition to provider costs, we are also expected to see a rise in what people are paying for pharmaceutical treatments in 2023. Paxlovid is expected to hit the private market in mid-2023. Those infected prior to the federal stockpile running out will be able to access the medication for free, however are responsible for the doctors appointment needed to obtain the prescription. Hannah Recht covered what to expect regarding Paxlovid costs brilliantly here, but if you’re in a rush: 

“The government will also stop paying for the company's COVID vaccine next year — those shots will quadruple in price, from the discount rate the government pays of $30 to about $120. Bourla told investors in November that he expects the move will make Paxlovid and its COVID vaccine ‘a multibillion-dollars franchise.’ Nearly 9 in 10 people dying from the virus now are 65 or older. Yet federal law restricts Medicare Part D — the prescription drug program that covers nearly 50 million seniors — from covering the COVID treatment pills. The medications are meant for those most at risk of serious illness, including seniors.”

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