Covid tests and treatments may no longer be free to all after the federal government's emergency declarations end in May. But most people still won't have to pay for Covid vaccinations, according to two reports released last week by KFF, a nonprofit health think tank.
The White House announced Monday that it would let the national and public health emergencies related to the Covid pandemic expire on May 11. The former has been in place since March 2020 and the latter since January 2020.
That will end some of the federal rules that eased consumer costs — for example, the requirement that insurance companies cover eight at-home Covid tests a month. However, other laws, like the Affordable Care Act, ensure that vaccinations will remain free to people with insurance.
The Department of Health and Human Services didn’t respond to a request for comment about how various coronavirus-related costs will change after May 11.
Here are some of the expected changes, according to KFF.
Insurance will no longer have to cover at-home tests
Since early 2022, the Biden administration has required private insurers and Medicare to cover up to eight at-home tests a month.
But once the public health emergency lifts, most people with private insurance will most likely have to pay out of pocket for those tests — unless the kits come from the dwindling federal supply, said an author of the two reports, Jennifer Kates, a senior vice president at KFF.
"For the most part, health plans aren't probably going to cover it. Some might, but most won't," Kates said.
People with Medicare and those who are uninsured will most likely be charged for at-home tests, as well. However, some people with Medicare Advantage, which covers additional services, may still get at-home tests covered depending on their plans.
Under the American Rescue Plan Act, people on Medicaid can get free at-home tests for about a year after the public health emergency ends. After that, coverage for at-home tests will vary by state.
The Biden administration hasn’t indicated any plans to ship more free at-home tests beyond those currently offered.
PCR test costs will vary depending on the situation
Most private insurers will continue to cover the cost of PCR, or laboratory, tests administered by in-network providers. But those insurers may require doctors' orders, limit the number of tests covered per person, charge for doctors’ visits or make the tests subject to copays or deductibles, according to KFF.
Medicare will continue to cover PCR tests, but people with Medicare Advantage may incur costs.
People without insurance will most likely have to pay for PCR tests, unless the tests were originally purchased by the federal government or are administered free through a clinic or a community health center.
Paxlovid and other antiviral treatments will eventually cost money
Oral antivirals that have been purchased by the federal government will remain free to everyone until the national supply runs out, regardless of when the public health emergency ends. That includes Paxlovid, the go-to treatment for people with mild to moderate Covid at high risk of severe disease.
But after the supply is emptied, most people — including those with private insurance or Medicare — will most likely be charged for the pills according to their plans.
People with Medicare Part D, which helps cover the cost of prescription drugs, can get Paxlovid free through December 2024, Kates said.
Most people will still get vaccinations at no cost
Covid vaccinations and boosters will remain free to people with Medicare, Medicaid and private insurance. Depending on their plans, however, some people with private insurance might still be charged if they are vaccinated through out-of-network providers.
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.
"Unless it’s a federally purchased vaccine or treatment or test, the uninsured do not have any guarantee for coverage," Kates said.
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.
President Joe Biden’s 2023 budget includes funding to create a "Vaccines for Adults" program modeled on the one for kids. If it is realized, the program would cover the cost of all recommended vaccinations for uninsured people; there is no timeline for that yet.