Federal COVID funding ends. Here’s what it means for Californians

The US government has spent billions fighting the COVID-19 pandemic, but the Biden administration has announced plans to end the purchase and free distribution of everything from COVID tests to vaccines because cases are dwindling and funding is drying up. The implications for California residents — and those in other states — are significant.

The Kaiser Family Foundation looked at how different groups of Californians will be affected by these changes. Here’s what the scan found if you have:

Health Insurance

Vaccines: You will continue to have access to all COVID-19 vaccines at no cost under Part B.
Treatments: When the public health emergency ends, you may be responsible for all or part of the cost of most treatments, including monoclonal antibody treatments. This is because most antiviral drugs, such as Paxlovid, are only permitted and not approved. Until FDA approval, Medicare is not expected to cover these treatments. Once approved, antivirals will be covered by Medicare Part D. But you may face “cost sharing” for antivirals, depending on your Part D plan, once the current supply runs out.
Trials: At the end of the public health emergency, you must pay the full cost of an at-home COVID test. However, some Medicare Advantage plans may cover the cost of home testing through an over-the-counter benefit or other coverage approach. Clinical diagnostic testing for COVID-19 disease will continue to be covered, but you may face “cost sharing” for testing-related services.

Private insurance

Vaccines: You will continue to pay nothing for COVID-19 vaccines, although there may be some exceptions, such as if you are vaccinated by an out-of-network provider. Since insurers will have to bear more of the cost of vaccines, this could drive up premiums.
Treatment: You may be responsible for part of the cost of most treatments, depending on your policy. Since insurers will be required to bear more of the cost of treatment, premiums could increase.
Trials: When the public health emergency ends, many people with private insurance will likely be subject to cost sharing for COVID-19 testing. Insurers may also limit testing coverage to in-network providers or require a prescription or doctor’s order for testing. Insurers can also limit the number of tests or stop covering the cost of testing altogether.

Medi-Cal

Vaccines: Children will have free access as part of the Vaccines for Children program. Adults will likely continue to receive vaccine coverage without cost sharing.
Treatments: Under the American Rescue Plan Act, Medi-Cal will pay for your COVID-19 treatments, without cost sharing, during the first quarter that begins one year after the health emergency ends. Once this period is over, your treatments will be covered, but you will likely have to pay part of the cost.
Trials: COVID-19 tests, including home tests, will be covered during the first quarter which begins one year after the end of the health emergency. Once this step is completed, your test will only be covered if ordered by a doctor. California may choose to cover testing without a doctor’s order, but you may have to pay part of the cost.

Not insured

Vaccines: Children will have free access as part of the Vaccines for Children program. It’s a different story for adults, whose free vaccines are based on congressional funding, and supplies are likely to be limited. Some may be able to obtain vaccines on a sliding scale from certain safety net providers, such as community health centers, but others will have to pay the full cost.
Treatments: You will be responsible for paying the full cost of the medication as well as any necessary medical or other visits. Some people may be able to obtain treatment on a sliding scale basis from certain safety net providers.
Trials: You will have to pay the full cost of the tests, although you can get free or discounted tests from local health departments or safety net providers.

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