Ending the public health emergency means the end of free COVID tests

The ending of the COVID-19 public health emergency on May 11 will mark the end of an era in the U.S. health system, as many Americans will have to start paying for care that, for the past three years, has been free.

Experts said the changes related to the public health emergency won’t be earth-shattering. When the public health emergency ends, the biggest change facing the majority of Americans will be that the days of free, easily accessible COVID-19 tests will likely end. 

Right now, everyone with private insurance can get up to eight tests a month. That will go away once the emergency ends. Private insurance may not cover the full price of over-the-counter tests anymore, and patients may need a prescription first for a PCR test. 

Vaccines and treatments will still be free, so long as the government supply lasts.

“On May 12, you can still walk into a pharmacy and get your bivalent vaccine. For free. On May 12, if you get COVID, you can still get your Paxlovid. For free. None of that changes,” White House COVID-19 Response Coordinator Ashish Jha tweeted on Wednesday. 

Jen Kates, a senior vice president at the Kaiser Family Foundation, said the ending of the public health emergency will be mostly symbolic. The nation still faces 400 to 500 COVID-related deaths per day and low vaccination rates. 

“It’s going to send a signal. Some people are going to hear that and say, I don’t have to worry about COVID anymore. And that’s not actually true. That’s not how this works,” Kates said. 

The flexibilities granted by the public health emergency (PHE) touched on almost all aspects of the U.S. health care system, and unwinding it will not be easy, though recent legislation made some of the most disruptive changes separate from the ending of the emergency.

For example, a requirement that states allow people to stay enrolled in Medicaid regardless of their eligibility will end in April. And Congress separately extended easier access to telehealth services through the end 2024. 

“I think there’s inevitably going to be some mess. I think that there’s no way to avoid that aspect of it,” Kates said. 

“The changes that were made were essentially, if you look at them as a whole, the closest we’ve probably come to universal health coverage in the United States. There’s cost sharing, there’s network issues, there’s deductibles. All of that was taken away … to protect people to allow providers to have more flexibility,” Kates said.

The biggest shock to the public is likely to occur once the federal supply of vaccines and treatments is exhausted, and the costs shift to the private sector. 

Vaccines will still be free to people with private insurance, though the cost will likely be reflected in premiums. Even with insurance, patients will likely see costs if they go to an out-of-network provider.  

Treatments like Paxlovid will also come with cost-sharing for people with private insurance. 

The White House has been urging Congress to provide billions more in funding to pay for a steady supply of COVID-19 vaccines and treatments, but lawmakers have shown no appetite for doing so.

The administration has been coordinating with manufacturers to make sure they have enough supply of tests, treatments and vaccines on hand to put onto the commercial market when the government involvement ends. 

But uninsured adults will have no guaranteed access to tests or treatments, though Jha indicated the administration is working on a plan.

“We are committed to ensuring that vaccines and treatments are accessible and not prohibitively expensive for uninsured Americans,” Jha said. “When the PHE ends, access to free vaccines and treatments doesn’t go away. And over time, as we transition this to the regular healthcare system, we are going to make sure that COVID vaccines and treatments remain accessible and affordable for Americans.”

Pfizer executives have said the company expects to quadruple the cost of its COVID-19 shot, and charge between $110 and $130 per dose once the government contract ends. Moderna has floated a similar price increase. 

Eli Lilly’s monoclonal antibody treatment is already being sold directly to providers at a list price of $2,100 per dose, though it may not be effective against some of newer omicron subvariants.