How End of PHE Will Impact Consumer COVID-19 Healthcare Spending By Coverage Type

October 19, 2022 - Federal funding was crucial in enhancing access to coronavirus resources during the initial phases of the pandemic, but questions remain about what will occur when the public health emergency ends and how it will impact consumer healthcare spending, according to a Kaiser Family Foundation brief.

The end of the public health emergency is still undetermined. However, experts have projected that it will end in 2023. The scheduled termination has been pushed back multiple times. Its final termination will signal the end of various flexibilities and protections that have been tied to the declaration.

But in addition to the public health emergency, the federally purchased supply of coronavirus-related products is running low and policymakers have offered a solution.

Coronavirus vaccines are protected from the end of the public health emergency. However, these issues could produce challenges for treatment and testing access.

“These access challenges will also vary by payer, with the uninsured and the underinsured standing to lose the most,” the researchers found.

“Whereas these products will continue to be covered by both public and private insurance after the federal supply is depleted and the PHE protection period is over, albeit in some cases with cost sharing, this is not the case for adults who are uninsured, who will have limited access to free vaccines, and no coverage for the cost of treatments and tests.”

For vaccines, individuals on short-term health insurance plans and uninsured individuals are most likely to have to pay full cost for the drug when federal supplies run out.

The program that has been established to help cover uninsured adults’ coronavirus vaccines when the public health emergency ends will have limited availability. The Biden administration has included in its fiscal year 2023 budget request a recommendation to create a program that covers coronavirus vaccines for uninsured adults.

For coronavirus treatment, Medicare beneficiaries face a high risk and may also face a higher cost when the public health emergency ends. Oral antiviral treatments are covered under Medicare Part D, but cost may vary broadly after the declaration is over. Medicare does not have to cover these treatments until they get FDA approval.

In Medicaid and Children’s Health Insurance Program (CHIP), all programs must cover drugs and biological products for coronavirus treatment and prevention for free for eligible beneficiaries until the end of the first quarter in the year after the public health emergency ends. But after that, the coverage policies will vary widely.

Private payer members may see a slight uptick in their premium payments when the federal supplies run out.

Providers who treat uninsured individuals for coronavirus will be able to use government-purchased supplies until they run out. HHS has procured 60,000 doses of bebtelovimab, a coronavirus treatment, for the uninsured and underinsured. This store is expected to last through September 2023. The drug has been transitioned to the commercial market.

For coronavirus testing, Medicare beneficiaries and the uninsured will have to cover the full cost of at-home tests after the public health emergency ends. Medicaid and CHIP programs will have to cover testing as a mandatory lab service, given the right approvals. States can go beyond this rule and cover the test regardless of the provider’s approval, but that would be up to the state. Private payer members will likely face some amount of cost-sharing.

“Depending on the type of product (vaccines/boosters, treatments, or tests) and insurance coverage (Medicare, Medicaid/CHIP, private, or uninsured/underinsured), access problems could come in the form of new or higher cost sharing, more limited coverage, or both,” the researchers found.