Public Health Emergency for COVID-19 Ending
The U.S. Department of Health and Human Services (HHS) is ending the Public Health Emergency (PHE) for the virus on May 11, 2023. After this date, COVID-19 care covered under the PHE umbrella will follow standard benefits rules for plans.
What will happen post-PHE:
In-office visits, testing and treatments:
- What’s changing: COVID-19 testing, antibody testing and any associated office visits and tests will now be covered under standard plan benefits.
- What’s staying the same: Members are encouraged to visit providers in their network to receive the highest level of coverage for any service related to COVID-19 or otherwise.
- What’s changing: COVID-19 vaccines and boosters will now be covered under preventive care benefits, similar to annual flu vaccines.
- What’s staying the same: COVID vaccines are encouraged, covered and readily available.
- What’s changing: Over-the-counter COVID-19 tests will no longer be covered under plan benefits.
- What’s staying the same: Over-the-counter tests are readily available at members’ local retailers and pharmacies.
- What’s changing: The Telemedicine/Telehealth administrative policy is updated.
- What’s staying the same: Telemedicine services are broadly covered and reimbursement amounts telemedicine claims (claims billed with POS 02, 10) will remain the same for the remainder of 2023. Any future changes in reimbursement will be communicated via fee schedule. For Medicare members, the Consolidated Appropriations Act of 2023 extended certain Medicare telehealth flexibilities through 12/31/2024. Please see the Telemedicine policy for more information.
Testing by non-contracted providers:
- What’s changing: COVID-19 tests by non-contracted, out of network providers will be covered under each member’s out of network plan benefits. During the PHE, all COVID testing was covered at 100%.
- What’s staying the same: COVID-19 testing is readily available at members’ local retailers, pharmacies and at in-network providers.
CMS has also issued guidance on what changing with the end of the PHE. Please follow this link for more information: CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency | CMS