How the Closing of the PHE will Impact Members

The COVID-19 pandemic has an impact on the lives of all Americans one way or another. While many struggled with shifting working environments, health concerns, or lack of financial resources, health insures had to modify their coverage to meet the new needs of the public. A Public Health Emergency (PHE) was enacted on January 27, 2020, in response to the dangers of COVID-19.

The Biden Administration has provided a possible deadline for the PHE being the end of the 2021 calendar year. Despite this being months away, members on the ACA Marketplace must be aware of what the closing of the PHE will mean to them so they can properly prepare.

1. Changes in Medicaid Coverage

Due to many finding themselves in tough financial situations and lacking health care coverage as a result of the pandemic, the PHE expanded Medicaid coverage in efforts to provide relief to the public. Medicare covers the following:

• COVID-19 testing
• COVID-19 vaccine
• Private room if medically necessary
• Telehealth

These are only some of the changes in coverage brought by the PHE. As these expansions in coverage draw to a close, members must reach out to their insurers to ensure that they are still covered for the care they need. Everyone’s coverage is different, and states have varying approaches to accommodating the end of the PHE. Be mindful of future notices as more changes are to come.

2. Availability of Telehealth and Home Health Care

To save hospital beds and prevent unnecessary exposure, both telehealth and home care become much more widely accessible during the pandemic and experienced an unprecedented boom. Offering a safe and more convenient way to engage with healthcare providers from the comforts of home, many are growing used to this new way of care.

During the heat of the pandemic and quarantines, the Centers for Medicare and Medicaid Services (CMS) took swift action to adopt temporary telemedicine approvals for eligible participants of those programs. At the time, Americans were told to stay home, creating a dilemma for those in need of health and wellness services. Telehealth provided a safe way to engage, and CMS made sure those appointments would continue to receive authorized coverage. And while the widespread adoption began in response to an emergency, it continues to be a viable and popular method today with at-home care and telehealth further expanding access to care.

Prior to the COVID-19 pandemic, coverage of telehealth services under traditional Medicare was extremely limited. In 2016, only 0.3% of Part B Medicare beneficiaries used any variation of telehealth services. During the PHE, the CMS expanded the coverage of telehealth services by Medicare and Medicaid plans dramatically. Between the Summer and Fall of 2020, one in four Medicare beneficiaries had a telehealth appointment.

Trump’s Executive Order on Improving Rural Health and Telehealth Access added more than 60 services to the Medicare telehealth list that will continue beyond the end of the PHE. The expansion of this coverage beyond rural areas is still in question.

The future of the span of telehealth and the coverage of home care is called into question as we near the end of the PHE. Supports of the expansion of healthcare coverage following the end of the PHE stress the importance of expanding access to care for underserved areas that lack traditional means of meeting with their providers.

The American Medical Association (AMA) weighs in on telehealth conversation with suggestions for potential expansion of audio-only telehealth. Officials strongly urged CMS to continue supporting these options post PHE.

Officials also predict the need for these types of remote-centric engagements won’t end when the PHE does; regardless, consumers must be ready for some modifications and prepare for the potential reduction in accessible care.

3. Medicaid Reassessments Will Begin Again

The qualifications for Medicaid eligibility have expanded under the PHE due to new income cut-offs and assets being disregarded. Additionally, states have not been redetermining Medicaid eligibility for current enrollees, so it is possible that members may no longer be eligible once reassessment begins at the end of the PHE.

Some states have expressed their plans to communicate with current enrollees to confirm information related to their coverage to ensure that this reassessment process goes as seamlessly as possible. Members should be aware of this upcoming process and check with their insurers to make sure they are staying up to date with requirements and getting the coverage that they are eligible for.

Assuming that a decent number of people will lose at least a portion of their coverage come the end of the PHE, making plans in advance will help mitigate potential issues and give time to find another affordable option for coverage. Considering recent legislation, new savings can be found of the Marketplace. Current are new members should ensure they are paying the least amount possible for the plan that fits their needs.

The ACA Marketplace continues to see growth and participation. Its reinforced structure, the surge in funding, additional support, and the overwhelming need for its benefits will ensure it continues to thrive in the years to come. To learn more about exploring your options with the ACA Marketplace, start with W3LL! Let us help you leverage the latest advantages of the bigger and better platform that is the ACA Marketplace today.