Information obtained and consolidated from the Centers for Medicare and Medicaid Services and MassHealth Eligibility Redetermination Outreach Toolkit
The Department of Health and Human Services is planning for the federal Public Health Emergency (PHE) for COVID-19 to expire at the end of the day on May 11th, 2023.
What this means for those with Medicare
Vaccination:People with Medicare coverage will continue to have access to COVID-19 vaccinations without cost sharing after the end of the PHE.
Testing: People with traditional Medicare may continue to receive COVID-19 PCR and antigen tests without any cost sharing when the test is ordered by a medical professional (MDs, PAs, NPs). However, cost sharing might change for those with Medicare Advantage (MA} after the end of the PHE. Some MA plans may continue to provide coverage as a supplemental
Treatment: The ending of the PHE does not change access to antivirals such as Paxlovid and Lagevrio. Cases where cost sharing and deductibles apply now will continue to apply after the ending of the PHE.
What this means for those with Medicaid and CHIP (MassHealth)
Vaccines, Testing, and Treatment: Due to the America11 Rescue Plan Act of 2021 (ARPA)states must provide MassHealth (Medicaid and CHIP} coverage without cost sharing for COVID-19 vaccination, testing, and treatment through the last day of the first calendar quarter that begins one year after the last day of the COVID-19 PHE. This day will fall on September 30th, 2024.
MassHealth: You will need to prove that you are eligible every year. During the PHE, people who had health insurance through MassHealth were automatically re-enrolled each Asof April 1st, people will need to prove that they are eligible for MassHealth every year.
What this means for those with Private Health Insurance
Vaccines: Most private health insurances will continue to cover COVID-19 vaccines givenby an in-network health care provider without cost People with private healthinsurance may need to pay part of the cost if an out-of-network provider vaccinates them.
Testing: Mandatory coverage for over-the-counter and lab-based PCR/antigen tests will end on May 11th, 2023 and coverage will vary depending on the health plan. If a plan decides to cover these services, there might be cost sharing, prior approval, or other forms of medical management required for purchase.
Treatment: The ending of the PHE does not change access to antivirals such as Paxlovid and Lagevrio. Cases where cost sharing and deductibles apply now will continue to apply after the ending of the PHE.