With the end of the COVID emergency, will I have to pay for the tests?
States of emergency issued in response to the COVID-19 pandemic are fast approaching their expiration dates, but Californians will still be able to get help with the cost of a key resource: testing.
While a federal requirement that insurers reimburse covered people for eight at-home COVID-19 tests per month will end with the nationwide public health emergency on May 11, state lawmakers have acted to maintain this requirement for the most California Department-regulated health plans. managed health care. That covers about 23.5 million people with private insurance or health plans run by Medi-Cal, the government’s insurance program for low-income residents.
State lawmakers have also passed legislation requiring health plans and insurers to cover COVID-19 drugs.
Here’s what you need to know:
Will California policyholders still be able to benefit from free home tests?
Yes. Starting in January 2022, federal authorities ordered health insurers to reimburse customers for eight over-the-counter COVID-19 home tests per month per covered person. In other words, a family of four would be eligible for reimbursement for 32 COVID tests per month, up to $12 per test.
However, this federal mandate is only in place as long as COVID-19 remains a public health emergency.
In California, state lawmakers and Governor Gavin Newsom have acted in recent years to maintain that advantage. Senate Bill 510, authored by then-state Senator Richard Pan, requires health plans to cover costs associated with COVID-19 testing and vaccination — even after the expiry of the federal public health emergency. This bill easily obliterated both houses of the Legislative Assembly and Newsom signed it into law in October 2021.
Another pan-sponsor bill, SB 1473, was approved in September and requires health insurers to keep current reimbursement rules for six months after the federal public health emergency ends. According to state health officials, that means policyholders can still claim reimbursement for at-home COVID-19 tests purchased from stores or online retailers, as they did last year.
But from early November – six months after the public health emergency ended – things are changing slightly. Insured people will need to take COVID-19 tests through an “in-network” provider to avoid a fee. It is therefore best to contact your mutual insurance company to find out how to continue to benefit from free or reimbursed tests.
“Health plans must continue to provide eight free over-the-counter home tests per month to enrollees. Plans can meet this requirement by providing testing directly to enrollees through network providers and pharmacies, which could include [retail outlets] if they are considered part of the network for the plan,” the California Health and Human Services Agency said in a statement to The Times. However, if the health insurer deemed retail stores such as Amazon, CVS, Walgreens, or Rite Aid “out of network”, health insurers may begin charging the registrant a fee for COVID-19 testing in free sale.
Other parts of the United States may not maintain such requirements. The federal government will no longer order insurers to keep home testing free once the public health emergency has expired.
“It ends when the public health emergency ends,” White House COVID-19 response coordinator Dr. Ashish Jha said during an online forum with the chairman of the Department of Medicine. UC San Francisco, Dr. Robert Wachter.
Jha said he hopes “every insurance company will continue to cover COVID testing beyond this. …It’s the right thing to do.
What about anti-COVID drugs and vaccines?
Even after the federal public health emergency ends, insured Californians will still have free access to anti-COVID medications. SB 1473 requires health plans to fully cover the costs of treatments, including antiviral oral pills that treat COVID.
Until early November, insured persons can obtain these drugs free of charge from in-network or out-of-network providers. But from the beginning of November, the insured will have to stay in the network to avoid paying for COVID drugs.
COVID-19 vaccines will remain free nationwide for insured persons since preventive services are free under the Affordable Care Act of 2010, and vaccines are a preventive service, according to Jha.
What about uninsured people?
The picture is a little murkier, but officials say nothing should change in the short term.
“On May 12, you can still walk into a pharmacy and get your bivalent vaccine for free,” Jha said. writing on Twitter last week. “On May 12, if you catch COVID, you can still get your Paxlovid [anti-COVID pills] free. None of this changes.
The reason for this is that the US government has already purchased large quantities of vaccines and medicines and can still draw on this supply. But Congress hasn’t funded efforts to fight the COVID-19 pandemic in more than a year, and those federal stocks will run out at some point.
Eventually, “we will transition from vaccines and treatments distributed by the US government to those purchased through the regular health care system, just as we do for all other vaccines and treatments,” Jha said last week.
Federal officials are working to ensure vaccines and treatments remain readily available to uninsured people, he said.
“We are working on a plan for this. But none of this needs to be implemented like next month, because first, the [federal public health emergency] only ends in May. But even after that, this material will be available for the uninsured and for everyone for a while. So at some point from summer to fall you will see this transition,” Jha said.
Los Angeles County Public Health Director Barbara Ferrer said county health sites will continue to provide vaccines, COVID-19 medications and test kits free of charge, including to those who are not insured or underinsured. “We need to work with the federal government and the state government to ensure that we are able to continue these services well beyond emergency declarations,” Ferrer said.
In the meantime, she said, “as access to vaccines, boosters, tests and treatments is both readily available – and for almost everyone it’s free – we urge all the world to use these life-saving tools appropriately”.
The California Department of Public Health has urged health care providers to prescribe anti-COVID drugs such as Paxlovid and molnupiravir more often. Officials have raised concerns that too many providers have avoided prescribing the treatments despite their lifesaving potential.
“There is an abundant supply of COVID-19 therapeutic agents, but they have been underutilized – especially among populations disproportionately affected by COVID-19, including communities of color, low-income communities and residents of long-term care facilities,” health officials said in a recent memo to health care providers.
Los Angeles Times