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FAQ: Review Patient-Centered Changes for the End of the PHE

Analysis  |  By Amanda Norris  
   May 10, 2023

Revenue cycle success is closely tied to the patient experience, so make sure to keep the patient in mind and up-to-date as the PHE ends this week.

This week’s end in the COVID-19 public health emergency (PHE) will affect specific patient services, such as COVID-19 treatment and telehealth services. As the revenue cycle is closely tied to the patient experience, making sure staff is well-versed in these upcoming changes will not only create a more positive patient experience, but help streamline reimbursement operations during the transition.

Front-end staff especially may be fielding ample questions as patients notice changes in coverage and reimbursement this week. So, below is a summary of frequently asked questions courtesy of Revenue Cycle Advisor that clarifies what will and will not change for certain provisions once the PHE ends. 

CMS said the federal government, individual states, or insurance companies may announce additional changes in the future, but for now, here are some changes staff should be aware of.

Q: Can our patients still obtain free COVID-19 vaccines?

A: For patients with Medicare, Medicaid, or coverage under the Children’s Health Insurance Program (CHIP), vaccines will be 100% covered until “the last day of the first calendar quarter that begins one year after the last day of the COVID-19 PHE,” according to CMS. As of now, this is expected to be September 30, 2024. While Medicare didn’t list an end date for vaccine coverage, Medicaid and CHIP coverage may change after that expected date. This is when the American Rescue Plan Act of 2021 (ARPA) provision, which requires these services to be provided without cost sharing, expires. It’s unclear whether coverage will change after that point.

Many people with private health insurance will still be able to get vaccinated without paying any additional money out of pocket. However, some private plans may ask patients to pay part of the cost if they get a vaccine from an out-of-network provider.

Q: Will COVID-19 tests still be covered for our patients?

A: For people with traditional Medicare, both COVID-19 PCR and antigen tests will still be free, provided they are performed in a lab and ordered by a physician or another qualifying healthcare provider. Medicare Advantage beneficiaries can still obtain tests, but they may have to pay a percentage of the costs. 

“By law, Medicare does not generally cover over-the-counter services and tests,” said CMS. “Current access to free over-the-counter COVID-19 tests will end with the end of the PHE. However, some Medicare Advantage plans may continue to provide coverage as a supplemental benefit.”

Medicaid and CHIP beneficiaries will have the same coverage for COVID-19 tests until the last day of the first quarter that begins one year after the last day of the PHE—which means coverage will continue through September 30, 2024, if the PHE ends as scheduled. After that point, changes may be made.

Private insurers may or may not charge for COVID-19 laboratory tests. Some people will still be able to get free testing depending on their coverage, but others will need to pay out of pocket.

Q: How will the end of the PHE affect our patient’s COVID-19 treatment?

A: Treatment for COVID-19 will stay the same for Medicare beneficiaries once the PHE ends.

Medicaid and CHIP beneficiaries will still be eligible for treatment under the same rules that applied during the PHE until the last day of the first quarter that begins one year after the last day of the PHE (September 30, 2024). After that, coverage may continue but could vary by state.

People with private insurance will probably not see any changes related to treatment coverage.

Q: What will happen to telehealth coverage after the PHE ends?

A: Many telehealth services will still be available to Medicare beneficiaries through December 31, 2024, according to CMS. For example, telehealth services will continue to be available for those in any location, not just rural areas. Medicare will pay for in-home telehealth visits, and telephone telehealth visits are allowed if audio and video are too challenging for the patient. CMS provided additional details about the transition here.

Coverage may vary by state for those with Medicaid, CHIP, Medicare Advantage, and private health insurance.


Amanda Norris is the Associate Content Manager of Finance, Payer, Revenue Cycle, and Strategy for HealthLeaders.

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