Written by L. M. Land
At the end of the day on May 11, 2023, the Public Readiness and Emergency Preparedness (PREP) Act for medical countermeasures against COVID-19 ended and subtle changes in your medical plans are already in effect. In other words, the COVID-19 Public Health Emergency (PHE) policy is being amended based on the fact that the virus is no longer as disruptive or acute as it has been in the last three years.
This is good news. Since January 2021, COVID-19 deaths have declined by 95% and hospitalizations are down nearly 91%.
This does NOT mean COVID-19 itself is gone.
This does NOT mean another COVID-19 major outbreak will never happen again. It might happen again, and is happening on a smaller scale still throughout the country. There are still populations at high risk for infection, especially seniors, those with disabilities and/or who are immunocompromised. Nursing home infections, in particular, are still high in the Genesee County area. The Detroit area has an outbreak in public schools.
Therefore, the spread of SARS-CoV-2, the virus that causes COVID-19, remains a public health priority. As it continues to mutate, vaccines are being adapted for new variants, just like flu shots. We all still need to keep up on the booster shots to prevent outbreaks in our community.
What do these changes mean for you?
The end of the Public Health Emergency (PHE) means the government is beginning to transition COVID health care, vaccines and tests, to the normal health care system you use for medical treatment. This process includes many agencies and may be changed or adapted as time goes by.
The government is going to stop purchasing and distributing the COVID vaccines by the end of 2023. Once the federal government is no longer purchasing or distributing COVID-19 vaccines and treatments, there may be changes for you. The Administration has facilitated access to COVID-19 vaccines with no out-of-pocket costs for most individuals and will continue to ensure that effective COVID-19 treatments, such as Paxlovid, are widely accessible.
There are many policy changes in PREP act that will affect providers, like doctors and pharmacists.
For you personally, the biggest changes seem to be whether or not you will be paying for the vaccine or COVID testing or not. Below is a list of changes that may be most noticeable for you in real life. This is not a complete list, and policies and procedures may still change as COVID care transitions to insurance carriers. Be sure to stay aware of updates from your own insurance carrier.
If you don’t have a computer to read the policies and updates, the public library systems in Genesee County have computers you can use for free.
Uninsured persons: The “HHS Bridge Access Program For COVID-19 Vaccines and Treatments” (“Bridge” Program) was announced on April 18, to provide uninsured Americans vaccines and treatment after the transition to the regular healthcare market. The program will create a unique $1.1 billion public-private partnership to help maintain uninsured individuals’ access to COVID-19 care at their local pharmacies, through existing public health infrastructure, and at their local health centers.
For testing, the Centers for Disease Control and Prevention’s (CDC) Increasing Community Access to Testing (ICATT) program will continue to focus on no-cost testing for uninsured individuals and areas of high social vulnerability through pharmacies and community-based sites. For more information, visit CDC’s ICATT website.
Private insurance: COVID-19 vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are a preventive health service and will be fully covered without a co-pay when provided by a provider who is an “in-network provider” for that plan. Before getting the shot, make sure the giver of the shot is part of your insurance plan, or you may end up with a large bill. Call your carrier to find out where they want you to get your shot.
Getting COVID-19 tests without copays, both for over-the-counter and laboratory tests, ended on May 11, 2023. Plans may continue to cover them if they chose. So, call your plan to find out.
Medicare Part B: Vaccines should be fully covered, unless you have a Medicare Advantage plan. Medicare Advantage plans must cover COVID-19 vaccinations in-network without copays. As above, before you get the shot make sure the giver of the shot is in-network for your plan, or you will be charged. Call your provider to find where you should go for the vaccine.
COVID testing is similar. Traditional Medicare enrollees can continue to receive COVID-19 PCR and antigen tests with no cost-sharing when the lab tests are ordered by a physician or certain other healthcare providers, such as physician assistants and advanced practice registered nurses.
People enrolled in Medicare Advantage plans can continue to receive COVID-19 PCR and antigen tests when the test is covered by Medicare, but they might have copays. Medicare Advantage plans may continue to cover the tests, call your plan to find out.
Medicaid will continue to cover COVID-19 vaccinations without a co-pay through September 30, 2024, and will generally cover ACIP-recommended vaccines for most beneficiaries thereafter. This may vary from state to state. COVID Testing is also covered through September 30, 2024. After that date coverage may vary state by state.
Copays for certain treatments, such as Paxlovid and Lagevrio, may change, depending on your health care coverage. This will depend on your pharmacy plan.
Medicaid programs will continue to cover COVID-19 treatments without copays through September 30, 2024. After that, coverage and cost-sharing may vary by state.
Telehealth will not be affected for Medicare, especially in rural areas, through December 2024. For Medicaid, states have flexibility to cover or not cover telehealth services.
The government has and will continue to coordinate a whole-of-government response to the longer-term effects of COVID-19, including long COVID-19 and associated conditions. The Courier does not know how that will be handled on an individual person basis.
For more information about the “Bridge” Program, visit Fact Sheet: HHS Announces ‘HHS Bridge Access Program For COVID-19 Vaccines and Treatments’ to Maintain Access to COVID-19 Care for the Uninsured below:
For more information about access to COVID-19 vaccinations and treatments, visit CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency – PDF.
Other Sources: https://www.hhs.gov/about/news/2023/04/14/factsheet-hhs-announces-amend-declaration-prep-act-medical-countermeasures-against-covid19.html