When the U.S. COVID-19 public health emergency ends this month, coronavirus tests will still be available, but there will be changes to who pays for them.
Questions remain about exactly what those coverage changes will look like, but the guarantee of free testing will be lost for many -- and some costs may shift to become out-of-pocket.
There are still ways to take advantage of the benefits provided by the public health emergency before it expires May 11.
For the past two years, the federal government has required private insurance companies to cover up to eight COVID-19 tests each month. Packs of home tests can be found at pharmacies and other local retailers, and costs may be covered upfront or reimbursed by insurance plans.
The Biden administration launched COVIDtests.gov in January 2022 to allow US households to order free test kits to be delivered to home. The site is still up and running, with four free tests available to any household that hasn't ordered since December.
Also, the U.S. Food and Drug Administration has extended the expiration date for many home tests beyond what is printed on the box. Check the agency's website before throwing them out.
"People should go out and ensure that they have tests available, because what we know about COVID is it's quite pernicious, and clearly, people can get it more than once," said Mara Aspinall, a professor at Arizona State University's College of Health Solutions and a testing and diagnostics expert.
"It's critical that people have the ability to test and then isolate or stay at home if they test positive."
What will change after May 11?
Once the public health emergency ends, COVID-19 tests -- both home tests and laboratory tests -- will be subject to cost sharing, in which costs of services are divided between the patient and their insurance plan.
Private insurers will no longer be required to cover the costs of testing. The federal government has encouraged continued coverage, but each company will ultimately be able to make their own decision. So far, details on those plans are scarce.
The Blue Cross Blue Shield Association told CNN that it's evaluating the best way to keep members informed of changes. Moving into the next phase, coverage may include "reasonable limits" on tests.
"As COVID-19 becomes endemic, each Blue Cross and Blue Shield company is looking at how best to support access to diagnostic testing for COVID-19, just as is done for all other diagnostic testing," said David Merritt, senior vice president of policy and advocacy for the Blue Cross Blue Shield Association. "We are committed to protecting patients from unnecessary costs, while ensuring they receive the care they need, when they need it."
Aetna told CNN that it did not have any details to share. Cigna, Humana and UnitedHealthcare did not respond to multiple requests for comment.
Medicare Part B beneficiaries will continue to have coverage for lab tests when ordered by a provider, but the same will not apply for home tests.
For those on Medicaid plans, all tests will continue to be covered for free until the end of September 2024.
The U.S. Centers for Disease Control and Prevention will also continue to support uninsured individuals and socially vulnerable communities "pending resource availability," according to a roadmap outlined by the US Department of Health and Human Services.
There may be other avenues to free or cheap testing, too -- perhaps through state and local governments or other programs.
Recently, for example, the North Carolina Department of Health and Human Services announced the expansion of a program that now allows all state residents to order free tests through June.
The Rockefeller Foundation, a private philanthropic organization, has also extended a public-private partnership program that works with states to get free tests to at-risk communities.
Shifting role of testing
"The testing phenomenon during COVID changed many times," Aspinall said.
It was a core focus at the beginning, but the priority then shifted to vaccines, she said. The initial Omicron wave brought a renewed interest in testing, and long waits for lab-based tests drove people to home tests.
"It put power and privacy in an individual consumer's hand," Aspinall said.
Millions of households took advantage of free COVID-19 tests provided by the federal government in the months after it launched, and a recent CDC report shows that the program helped to get kits to many who otherwise wouldn't have tested and improved equity in testing overall.
About 60% of US households ordered a test kit from COVIDTests.gov, and nearly a third of all US households reported using at least one of those tests by April or May last year.
Nearly a quarter of people who reported using the government-provided tests said that they probably would not have tested for Covid-19 if not for the free kits, according to the report -- suggesting that more than 13 million people took a Covid-19 test who otherwise wouldn't have. More than 1 in 5 people who used their free tests reported at least one positive result.
Overall, use of the free test kits was similar across racial and ethnic groups. This is a "considerable difference" from other home test kits, where use was "highly inequitable," according to the report. Black people were more likely than White people to use tests provided through COVIDTests.gov but 72% less likely than White people to use other at-home test kits.
Now, however, COVID-19 cases are a third of what they were a year ago, and hospitalizations and deaths are about as low as they've ever been. Testing rates have dropped significantly, too.
Along with the decreased transmission, the volume of testing may have dropped as people better understand what the course of an infection looks like, Aspinall said.
She estimates that people may use an average of one or two tests per incident, down from an average of five or six.
While COVID-19 "remains a public health priority," the federal government says "we are in a better place in our response than we were three years ago, and we can transition away from the emergency phase."
Still, experts agree that continued monitoring is key. Advancements in technologies like wastewater surveillance have helped supplement dwindling testing data, but testing will continue to be an important tool for individuals to keep themselves and their loved ones safe and healthy.
"The public health emergency may be over but COVID is not over," Aspinall said.
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