Federal Public Health Emergency FAQ
The Federal Public Health Emergency ends on May 11, 2023. On January 30, 2023, the Biden administration announced that federal emergency declarations related to the COVID-19 pandemic expire on May 11, 2023. There are many coverage and cost-share waivers tied to the federal public health emergency (PHE). These may affect Highmark members insurance coverage and out-of-pocket costs.
Given our ongoing commitment to support our members, clients and providers throughout the COVID-19 pandemic, Highmark will extend the following waivers to Highmark members with employer-sponsored or individual health insurance coverage until June 1, 2023*:
- $0 in-network and out-of-network COVID-19 vaccines
- $0 in-network and out-of-network COVID-19 diagnostic and antibody testing
- $0 over-the-counter (OTC) COVID-19 testing
- $0 Prescription antiviral treatment
- $0 in-network and out-of-network related services to diagnose COVID-19 - office visit (in-person or telehealth), emergency room or urgent care
For Medicare Advantage members, Highmark will extend the following waivers with Highmark Medicare Advantage insurance coverage until June 1, 2023*:
- $0 in-network and out-of-network COVID-19 vaccines
- $0 in-network and out-of-network COVID-19 diagnostic and antibody testing
- $0 in-network and out-of-network related services to diagnose COVID-19. Includes office visits (in-person or telehealth), emergency room visits or urgent care visits.
- $0 inpatient COVID-19 treatment – covered through 12/31/23 for Medicare Advantage members
*While this coverage applies to most Highmark members, every plan is a little different. If you have any questions, please login to your member portal and send a message using the message center to Member Service. You can also call Member Service using the number on the back of your insurance card.
** West Virginia Members: Please note that WV State mandates may continue to be in place and extend coverage of these services after 6/1/2023. Please continue to check back here for updates.
After June 1, 2023, the services above may have out-of-pocket costs based on your plan coverage.
No, due to government regulations all out-of-network claims will be processed according to your Medicare Advantage plan benefits beginning on June 11, 2023.
If you choose to see an out-of-network provider on or after June 11th, and your plan has out-of-network benefits, you may see a change in the amount you owe. If you choose to see an out-of-network provider on or after June 11th, and your plan does not have out-of-network benefits, you will have to pay the full amount owed (except for urgent or emergency care).
Please check your Summary of Benefits to find out if your Medicare Advantage plan has out-of-network benefits.
For members with Highmark employer-sponsored or individual health insurance coverage, Highmark will continue to cover inpatient COVID-19 treatment based on the member’s plan coverage for in-patient services. This may mean there will be out-of-pocket costs based on your plan.
For Highmark Medicare Advantage members, inpatient COVID-19 treatment will be fully covered through December 31, 2023.
Yes, Highmark will continue to cover EUA vaccines, tests, and treatments. The ending of the PHE will not impact FDA’s ability to authorize tests, treatments, or vaccines for emergency use.
