What the End of COVID Emergencies Means for Older Adults

Treatments may come with costs, too

Oral antiviral treatments like Paxlovid and a similar drug called Lagevrio (molnupiravir) have helped to keep many adults with COVID-19 out of the hospital. And ever since they became available, in late 2021, they’ve been free for Americans.

These oral antivirals will still be covered for Medicare beneficiaries with a Part D prescription drug plan or Medicare Advantage plans that cover prescription drugs, at least until the federal supply is depleted. After that point, cost sharing may kick in, depending on your plan, according to KFF.

When it comes to Medicaid, KFF notes that once the coverage period mandated by the American Rescue Plan Act ends next year, treatments that have FDA approval will be covered, but cost sharing could kick in. And coverage will vary by state for treatments that are under emergency use authorization (EUA).

Coverage for COVID treatments under private insurance will likely vary by plan. For people without insurance, treatments will no longer be free once the federal supply is tapped. A five-day course of Paxlovid currently costs the government about $530.

“People who are the lowest income and uninsured are going to face the greatest changes as a result of the end of the public health emergency, and face considerable costs for treatment if they don’t have coverage,” Sinaiko says.

Changes in other flexibilities

Beyond vaccines, tests and treatments, the emergency declarations have granted a range of flexibilities within the health care system that will end. For example: the three-day hospitalization requirement that Medicare patients had to meet before continued care at a skilled nursing facility would be covered. That rule, which was waived during the pandemic, will go back into effect when the emergency declarations end.

And throughout the pandemic, Medicare Advantage plans have been required to charge in-network prices for care provided at out-of-network facilities. This flexibility will also expire when the emergency declarations end, Sinaiko notes.

A bigger change on the horizon has to do with Medicaid coverage. People who have been on Medicaid these last few years could soon be without it when the continuous enrollment provision ends on March 31. (This benefit, which barred states from removing people from Medicaid during the pandemic, was previously tied to the public health emergency but will end earlier.) In fact, KFF estimates that between 5 million and 14 million people could lose their Medicaid insurance.

It’s important for people with Medicaid to pay attention to their plan, says Salama Freed, an assistant professor in the Department of Health Policy and Management at George Washington University’s Milken Institute School of Public Health. And if they get disenrolled, they’ll need to have another option and prepare for any extra costs.  

“I don’t want anyone to be caught off guard losing their insurance coverage and have to scramble and find something else,” Freed says. “I just want people to have their ducks in a row, so that they’re not caught flat-footed.”

Some people who get disenrolled from Medicaid may be eligible for Medicare, and Sharfstein says it’s going to be important for states to identify these people and to help them enroll in new coverage plans. For people not yet eligible for Medicare, there will be a temporary special enrollment period for plans on HealthCare.gov.

One change brought on by the pandemic that’s sticking around, at least for now, is expanded telehealth. More than 28 million Medicare beneficiaries dialed into doctors’ appointments during the first year of the pandemic, a report from the Department of Health and Human Services shows. And new legislation extends telehealth benefits for Medicare beneficiaries through 2024. Similarly, most states have adopted the telehealth expansions for Medicaid, KFF reports.

End of emergencies doesn’t mean end of COVID-19

One thing that doesn’t end when the declarations do is COVID-19, Sharfstein points out. Cases, deaths and hospitalizations have plummeted since the peak of the omicron surge last winter. Still, more than 3,700 Americans are dying each week from COVID-19, federal data shows.

People should “continue paying attention to the virus,” Sharfstein says. Stay up to date on your vaccines, he advises, watch out for symptoms, and test yourself if you’re going to be around vulnerable people. “The virus doesn’t care whether there’s a public health emergency declaration or not,” Sharfstein says.​​