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What the End of COVID Emergencies Means for Older Adults

Many Americans could see changes in charges and coverage going forward

COVID home tests, COVID vaccine vial, and closeup of Paxlovid box with pills on top
Joe Raedle / Getty Images

The COVID-19 national and public health emergencies that went into effect in early 2020 will end May 11, the White House announced Jan. 30. This will mark a symbolic end to a pandemic that has taken the lives of more than 1.1 million Americans.  

There is never a perfect time to end an emergency like this, says Joshua Sharfstein, M.D., vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health. But, he said, “I think this reflects the fact that COVID is under much better control than it was a couple years ago.”

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Since 2020, vaccines have been approved that can help keep people from getting seriously sick from a coronavirus infection, and there are now treatments that can help curb COVID complications. We also have greater access to fast, convenient testing and high-quality masks to tamp down on spread.

But the end of the pandemic emergency declarations will usher in a wave of changes that will affect how many people access these tools.

“One of the more immediate changes that people will notice is that they may be required to pay for things or face cost sharing for things that they have been getting for free under the public health emergency,” says Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF, also known as the Kaiser Family Foundation. And how much you end up paying will depend on the type of insurance you have, she adds.

Paying for COVID-19 vaccines

Medicare and Medicaid will fully cover the COVID-19 vaccines for their beneficiaries, and the majority of people with private insurance will also be covered, a new report from KFF details. But people without health insurance will have to pay for their shots once the federal supply is depleted, Cubanski says. It’s unclear how long it will take to get to that point, but it could happen within the next year or two, says Anna D. Sinaiko, an assistant professor of health economics and policy at the Harvard T.H. Chan School of Public Health.

Pfizer recently suggested that the price for its two-dose COVID vaccine could range from $110 to $130 per dose, while Moderna has said each of its two-dose shots could cost up to $100 on the commercial market. How often adults will need the vaccine is still unknown. The U.S. Food and Drug Administration (FDA) has proposed an annual booster schedule for most adults, but people at higher risk may need more frequent shots.

Testing will cost consumers

At-home COVID tests have been free for many Americans for about a year now. Medicare beneficiaries with Part B, which covers doctor visits and other outpatient services, have been able to get up to eight per month at no cost; private health plans have also been covering them. But when the emergency declarations end, that will no longer be the case.

Cubanski says people with original Medicare will most likely need to pay out of pocket for at-home testing, though tests ordered in a doctor’s office will still be fully covered. People with Medicare Advantage plans or private insurance may also have to start paying for some or all of these over-the-counter tests, Cubanski adds. And for people with Medicaid, coverage for at-home tests will vary by state, though tests ordered by a doctor will continue to be covered, according to KFF.

Currently Americans can still order four free at-home COVID tests per household from the federal government. Sinaiko’s advice: Get some to keep on hand while you still can.

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.

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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).

What About EUAs?

The FDA confirmed on Jan. 31 that the ending of the public health emergency will not affect the agency’s ability to authorize devices (including tests), treatments or vaccines for emergency use. “Existing emergency use authorizations (EUAs) for products will remain in effect and the agency may continue to issue new EUAs going forward when criteria for issuance are met,” the FDA said in a tweet. 

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.


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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

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.​​