The End of the COVID-19 Emergency: A Medicare Customer Question

The federal government's declared COVID-19 public health state of emergency finally came to an end on May 11, as weekly hospitalizations due to the virus are now at their lowest level since the pandemic.

The U.S. Department of Health and Human Services has issued a fact sheet with an update on the flexibilities offered during the COVID-19 state of emergency and how Americans will be affected now that the emergency is over.

Some of the changes could lead to clients facing the return of out-of-pocket costs.

The Question:

What does the end of the COVID-19 public health emergency mean for Medicare patients?

The Answer:

Here a look at how the conclusion of the public health emergency, or PHE, could affect your clients' Medicare coverage.

The major telehealth access improvements will not be affected right away.

During the pandemic, Medicare recipients, especially those in rural areas who had difficulty accessing care, relied on telehealth services to obtain the care they needed.

These same Medicare telehealth flexibilities will continue through December 2024.

Most Medicare recipients can get COVID-19 vaccines without paying cost-sharing amounts.

Clients with Original Medicare coverage can get their vaccines without facing out-of-pocket costs as long as their health care providers accept assignment for giving the shots.

Clients with Medicare Advantage plans need to contact their plan representative to see what's covered.

However, most Medicare Advantage beneficiaries will be able to get their COVID-19 shot for free as long as the service is obtained through an in-network provider.

Coverage for COVID-19 testing will change.

Over-the Counter Tests

Original Medicare no longer provides over-the-counter tests or at-home tests for free.

Medicare Advantage plan beneficiaries should check with their plans to see what their plans cover.

Tests Ordered by a Doctor, Physician Assistant or Advanced Practice Registered Nurse

Original Medicare recipients can continue to get PCR and antigen tests with no cost-sharing when the tests are ordered by a health care provider.

Clients in Medicare Advantage plans can get coverage for lab tests ordered by providers, but their cost-sharing responsibilities may have changed.

Treatments for COVID-19 will continue to be covered.

Medicare will continue to cover COVID-19 treatments now that the public health emergency is over, and cost sharing and deductibles remain applicable if already in place.

For the most part, Medicare Advantage beneficiaries' treatments should be covered if the same coverage is offered under an Original Medicare plan.

However, there may be some exceptions, and a client in a Medicare Advantage plan may need to see a health care provider within the plan's network.

The Centers for Medicare and Medicaid Services, the agency that oversees Medicare, provides more information about these post-public health emergency changes and others in a batch of answers to frequently asked questions posted here.

Bethany Cissell is an account executive and Medicare expert at Allsup, a national disability representation provider based in Belleville, Illinois.