The U.S. government has spent billions battling the COVID-19 pandemic, but the Biden administration has announced that it expects to end the purchase and free distribution of everything from COVID tests to vaccines because cases are dropping and funding is drying up. The implications for California residents – and those in other states – are significant.
The Kaiser Family Foundation has looked at how different groups of Californians will be affected by these changes. Here’s what the analysis found if you have:
Medicare
Vaccines: You will continue to have access to all COVID-19 vaccines at no cost under Part B.
Treatments: When the Public Health Emergency ends, you may be responsible for all or part of the cost for most treatments, including monoclonal antibody treatments. That’s because most antiviral drugs, such as Paxlovid, are only authorized, not approved. Until FDA approval, Medicare is not expected to cover these treatments. Once approved, antivirals will be covered under Medicare Part D. But you may face “cost sharing” for the antivirals, depending on your Part D plan. once the current supply is depleted.
Tests: When the Public Health Emergency ends, you must pay the full cost of an at-home COVID test. Some Medicare Advantage plans, however, may cover the cost of at-home tests through an over-the-counter benefit or other coverage approach. The clinical diagnostic testing for COVID-19 disease will continue to be covered, but you may face “cost sharing” for testing-related services.
Private Insurance
Vaccines: You will continue to pay nothing out-of-pocket for COVID-19 vaccines, although there may be some exceptions, such as if you get your shot from an out-of-network provider. Because insurers will be required to take on more of the cost of vaccines, that could nudge premiums higher.
Treatment: You may be responsible for part of the cost for most treatments, depending on your policy. Because insurers will be required to take on more of the cost of treatment, premiums could rise.
Tests: When the Public Health Emergency ends, many people with private insurance will likely be subject to cost sharing for COVID-19 tests. Insurers may also limit coverage of testing to in-network providers or require a prescription or physician’s order for testing. Insurers may also limit the number of tests or stop covering the cost of tests altogether.
Medi-Cal
Vaccines: Children will get free access under the Vaccines for Children Program. Adults likely will continue to get coverage of vaccines with no cost sharing.
Treatments: Under the American Rescue Plan Act, Medi-Cal will pay for your treatments for COVID–19, with no cost sharing, through the first quarter that begins one year after the health emergency ends. Once that’s over, your treatments will be covered, but you’ll likely need to pay part of the cost.
Tests: COVID-19 tests, including at-home tests, will be covered through the first quarter that begins one year after the health emergency ends. Once that’s over, your test will be covered only if it is ordered by a doctor. California may opt to cover tests without a doctor’s order, but you might have to pay part of the cost.
Uninsured
Vaccines: Children will get free access under the Vaccines for Children Program. It’s a different story for adults, whose free vaccines are based on Congressional funding, and it’s likely that supplies will be limited. Some may be able to get vaccines on a sliding-scale basis from certain safety net providers, such as community health centers, but others will have to pay full cost.
Treatments: You’ll have to pay the full cost for the medications plus any necessary physician or other visits. Some people may be able to get treatments on a sliding-scale basis from certain safety-net providers.
Tests: You’ll have to pay the full cost of tests, although you may be able to obtain free or reduced-cost tests from local health departments or safety net providers.
Source: www.mercurynews.com