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Your costs for Covid tests and treatments may rise after the public health emergency ends

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Your costs for Covid tests and treatments may rise after the public health emergency ends

Posted | Updated by Insights team:

Publication | Update:

May 2023
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Most people can expect to pay more for Covid tests after the federal public health emergency expires at the end of the day Thursday.

The emergency declaration guaranteed widespread access to free Covid-related health services starting in January 2020.

But once it ends, people with employer-based private health insurance could start paying for at-home Covid tests as well as rapid or lab tests at a doctor's office or clinic. Several large insurance companies — including UnitedHealthcare, Cigna and Aetna — have said their coverage of at-home tests, which cost about $ 11 on average, will end on Thursday.

In California, however, residents will have continued access to free tests, vaccines and treatments given by licensed health care providers through Nov. 11.

Additionally, the U.S. government is distributing free at-home tests from the national stockpile through the end of the month. The Department of Health and Human Services said Tuesday that the government could decide to ship more tests in the future depending on supply.

Federally purchased doses of Paxlovid — the go-to treatment for people at risk of severe disease — could also remain free as long as supply lasts, according to KFF, a nonprofit health think tank.

Here are the expected changes to Covid-related costs.

Tests will get more expensive

  • For people with private insurance: Insurers will no longer pay for up to eight free at-home tests per month. Rapid or laboratory tests ordered or administered by a clinician will be fully covered but subject to an individual's plan, so people may be responsible for paying deductibles or copays. Insurers could also limit the number of tests covered per person or require a prior authorization process.
  • For those on Medicare: People will no longer get up to eight at-home Covid tests per month covered, but lab tests ordered by a doctor or other health care provider won't cost anything out-of-pocket. Some people with Medicare Advantage may continue to get coverage for at-home tests depending on their plans, but they may incur costs for PCR or antigen tests.
  • For those on Medicaid: States must provide coverage for Covid tests of all kinds through Sept. 30, 2024. After that, coverage may vary by state.
  • For people without insurance: During the public health emergency, 18 states and U.S. territories covered the costs of Covid tests for people without insurance through Medicaid. That ends on Thursday, though people who are uninsured may still be able to find free testing through some community clinics.

Vaccines will largely remain covered

  • Private insurance: Vaccines and boosters will still be covered if administered by an in-network health care provider. People might be charged, however, if they are vaccinated by an out-of-network provider.
  • Medicare: Vaccines will remain covered if a patient's doctor or health care provider agrees to be paid directly by Medicare. Those with Medicare Advantage won’t be charged, either, if they use an in-network provider.
  • Medicaid: States must provide coverage without cost sharing through Sept. 30, 2024. After that, Medicaid will likely continue to cover the cost of vaccines.
  • No insurance: Medicaid coverage for vaccines will end in 18 states and U.S. territories, but an HHS program will make sure vaccines remain free to those who are uninsured.

Treatment costs will vary by insurance type

  • Private insurance: The federal government ordered and paid for a stockpile of Paxlovid, so many patients have until now gotten the antiviral for free, regardless of their insurance type. That will remain true as long as the stockpile lasts, but after that, Paxlovid costs will be subject to an individual's insurance plan, so people may incur copays or out-of-pocket expenses. Insurers are not required to waive out-of-pocket costs for Covid treatment such as antiviral pills, doctors' visits or in-hospital care. Some did so voluntarily during the public health emergency, though most insurers stopped covering treatment costs by 2021.
  • Medicare: Deductibles and out-of-pocket costs for treatment will stay the same for people with traditional Medicare, but Medicare Advantage may require patients to see in-network providers in order to get treatment covered. Paxlovid will remain free as long as the federal supply lasts, though people with Medicare Part D can get the drug at no out-of-pocket cost through December 2024.
  • Medicaid: States must provide coverage for Covid treatment through Sept. 30, 2024. After that, coverage may vary by state.
  • No insurance: Medicaid coverage for tests will end in 18 states and U.S. territories, but HHS will make sure people who are uninsured don't pay out-of-pocket for certain drugs like Paxlovid or Lagevrio (another oral antiviral). People may still be responsible for hospital fees or doctors' visits to obtain treatment, however.

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Forecast methodology

The future outlook “forecast” is based on a set of statistical methods such as regression analysis, industry specific drivers as well as analyst evaluations, as well as analysis of the trends that influence economic outcomes and business decision making.
The Global Economic Model is covering the political environment, the macroeconomic environment, market opportunities, policy towards free enterprise and competition, policy towards foreign investment, foreign trade and exchange controls, taxes, financing, the labour market and infrastructure. We aim update our market forecast to include the latest market developments and trends.

Forecasts, Data modelling and indicator normalisation

Review of independent forecasts for the main macroeconomic variables by the following organizations provide a holistic overview of the range of alternative opinions:

  • Cambridge Econometrics (CE)

  • The Centre for Economic and Business Research (CEBR)

  • Experian Economics (EE)

  • Oxford Economics (OE)

As a result, the reported forecasts derive from different forecasters and may not represent the view of any one forecaster over the whole of the forecast period. These projections provide an indication of what is, in our view most likely to happen, not what it will definitely happen.

Short- and medium-term forecasts are based on a “demand-side” forecasting framework, under the assumption that supply adjusts to meet demand either directly through changes in output or through the depletion of inventories.
Long-term projections rely on a supply-side framework, in which output is determined by the availability of labour and capital equipment and the growth in productivity.
Long-term growth prospects, are impacted by factors including the workforce capabilities, the openness of the economy to trade, the legal framework, fiscal policy, the degree of government regulation.

Direct contribution to GDP
The method for calculating the direct contribution of an industry to GDP, is to measure its ‘gross value added’ (GVA); that is, to calculate the difference between the industry’s total pre­tax revenue and its total bought­in costs (costs excluding wages and salaries).

Forecasts of GDP growth: GDP = CN+IN+GS+NEX

GDP growth estimates take into account:

  • Consumption, expressed as a function of income, wealth, prices and interest rates;

  • Investment as a function of the return on capital and changes in capacity utilization; Government spending as a function of intervention initiatives and state of the economy;

  • Net exports as a function of global economic conditions.

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Market Quantification
All relevant markets are quantified utilizing revenue figures for the forecast period. The Compound Annual Growth Rate (CAGR) within each segment is used to measure growth and to extrapolate data when figures are not publicly available.

Revenues

Our market segments reflect major categories and subcategories of the global market, followed by an analysis of statistical data covering national spending and international trade relations and patterns. Market values reflect revenues paid by the final customer / end user to vendors and service providers either directly or through distribution channels, excluding VAT. Local currencies are converted to USD using the yearly average exchange rates of local currencies to the USD for the respective year as provided by the IMF World Economic Outlook Database.

Industry Life Cycle Market Phase

Market phase is determined using factors in the Industry Life Cycle model. The adapted market phase definitions are as follows:

  • Nascent: New market need not yet determined; growth begins increasing toward end of cycle

  • Growth: Growth trajectory picks up; high growth rates

  • Mature: Typically fewer firms than growth phase, as dominant solutions continue to capture the majority of market share and market consolidation occurs, displaying lower growth rates that are typically on par with the general economy

  • Decline: Further market consolidation, rapidly declining growth rates

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The Global Economic Model
The Global Economic Model brings together macroeconomic and sectoral forecasts for quantifying the key relationships.

The model is a hybrid statistical model that uses macroeconomic variables and inter-industry linkages to forecast sectoral output. The model is used to forecast not just output, but prices, wages, employment and investment. The principal variables driving the industry model are the components of final demand, which directly or indirectly determine the demand facing each industry. However, other macroeconomic assumptions — in particular exchange rates, as well as world commodity prices — also enter into the equation, as well as other industry specific factors that have been or are expected to impact.

  • Vector Auto Regression (VAR) statistical models capturing the linear interdependencies among multiple time series, are best used for short-term forecasting, whereby shocks to demand will generate economic cycles that can be influenced by fiscal and monetary policy.

  • Dynamic-Stochastic Equilibrium (DSE) models replicate the behaviour of the economy by analyzing the interaction of economic variables, whereby output is determined by supply side factors, such as investment, demographics, labour participation and productivity.

  • Dynamic Econometric Error Correction (DEEC) modelling combines VAR and DSE models by estimating the speed at which a dependent variable returns to its equilibrium after a shock, as well as assessing the impact of a company, industry, new technology, regulation, or market change. DEEC modelling is best suited for forecasting.

Forecasts of GDP growth per capita based on these factors can then be combined with demographic projections to give forecasts for overall GDP growth.
Wherever possible, publicly available data from official sources are used for the latest available year. Qualitative indicators are normalised (on the basis of: Normalised x = (x - Min(x)) / (Max(x) - Min(x)) where Min(x) and Max(x) are, the lowest and highest values for any given indicator respectively) and then aggregated across categories to enable an overall comparison. The normalised value is then transformed into a positive number on a scale of 0 to 100. The weighting assigned to each indicator can be changed to reflect different assumptions about their relative importance.

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The principal explanatory variable in each industry’s output equation is the Total Demand variable, encompassing exogenous macroeconomic assumptions, consumer spending and investment, and intermediate demand for goods and services by sectors of the economy for use as inputs in the production of their own goods and services.

Elasticities
Elasticity measures the response of one economic variable to a change in another economic variable, whether the good or service is demanded as an input into a final product or whether it is the final product, and provides insight into the proportional impact of different economic actions and policy decisions.
Demand elasticities measure the change in the quantity demanded of a particular good or service as a result of changes to other economic variables, such as its own price, the price of competing or complementary goods and services, income levels, taxes.
Demand elasticities can be influenced by several factors. Each of these factors, along with the specific characteristics of the product, will interact to determine its overall responsiveness of demand to changes in prices and incomes.
The individual characteristics of a good or service will have an impact, but there are also a number of general factors that will typically affect the sensitivity of demand, such as the availability of substitutes, whereby the elasticity is typically higher the greater the number of available substitutes, as consumers can easily switch between different products.
The degree of necessity. Luxury products and habit forming ones, typically have a higher elasticity.
Proportion of the budget consumed by the item. Products that consume a large portion of the consumer’s budget tend to have greater elasticity.
Elasticities tend to be greater over the long run because consumers have more time to adjust their behaviour.
Finally, if the product or service is an input into a final product then the price elasticity will depend on the price elasticity of the final product, its cost share in the production costs, and the availability of substitutes for that good or service.

Prices
Prices are also forecast using an input-output framework. Input costs have two components; labour costs are driven by wages, while intermediate costs are computed as an input-output weighted aggregate of input sectors’ prices. Employment is a function of output and real sectoral wages, that are forecast as a function of whole economy growth in wages. Investment is forecast as a function of output and aggregate level business investment.

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