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On Medicare? What You’ll Pay for Now That the PHE Has Ended

The Biden administration officially ended the COVID-19 Public Health Emergency on May 11, 2023. Certain policies that were implemented in early 2020 during the public health emergency will now expire. As a result, seniors are among those who may see some of the health care costs related to COVID-19 change. Other health care services may or may not be affected, depending on what type of coverage you have.

Here are some of the highlights:

If You Are Enrolled in Original Medicare

  • With the end of the COVID-19 public health emergency, you will likely have to pay for:
    • At-home and over-the-counter COVID tests
    • Care in a skilled nursing facility if you have not first spent at least three days in a row admitted to a hospital (Note that being “under observation” at a hospital is not the same as being “admitted.”)
  • You generally will not have to pay for:
    • Laboratory COVID tests ordered by a health care provider, if you have Medicare Part B (Note that you may have to pay for part of the cost for your visit to the health care provider’s office)
    • COVID vaccines and boosters from a health care provider who takes Medicare
    • COVID oral antiviral treatments such as Paxlovid
  • Other considerations
    • In most cases, you will continue to have access to telehealth services from home through the end of 2024
    • With the end of the public health emergency, Medicare beneficiaries with Part D coverage may no longer receive three-month supplies of prescription medications

If You Are a Medicare Advantage Member

  • Now that the public health emergency has ended, you may have to pay at least part of the cost for:
    • At-home and over-the-counter COVID tests
    • Laboratory COVID tests ordered by a health care provider, including part of the cost of your visit to the health care provider’s office
    • Visits to out-of-network physicians
  • You will not have to pay for:
    • COVID vaccines provided by an in-network physician
  • Other considerations
    • Check with your individual plan regarding telehealth service access

For more information, visit the “What Does the End of the PHE Mean for You?” resource on the Centers for Disease Control and Prevention website.

For additional assistance with your Medicare coverage or for a referral to an insurance agent, contact a certified elder law attorney(*), such as Linda Strohschein and her team at Strohschein Law Group.  To set up an appointment, contact Strohschein Law Group at 630-300-0627.

This information provided by Strohschein Law Group is general in nature and is not intended to be legal advice, nor does it constitute a legal relationship.  Please consult an attorney for advice regarding your individual situation.

(*) The Supreme Court of Illinois does not recognize certifications of specialties in the practice of law and the CELA designation is not a requirement to practice law in Illinois.

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