FALLS CHURCH, Va. — The Public Health Emergency for COVID-19 expired at the end of May 11. Anyone might be wondering what this means about the state of COVID-19 or if there are changes to potential TRICARE coverage.
“COVID-19 is still a public health threat in the U.S. and around the world,” said Elan Green, chief of TRICARE Health Plan’s Member Benefits and Reimbursement Section. “But widescale efforts to mitigate the worst impacts of COVID-19 have helped us reach a point where we’re no longer in a state of emergency.”
Most Department of Defense COVID-19 activities won’t be directly affected by the end of the PHE. For example, TRICARE recipients still have access to COVID-19 vaccines, testing and treatments through TRICARE. And many telehealth services are now a permanent TRICARE benefit. But keep these changes in mind:
• COVID-19 Testing: There may be a cost-share for COVID-19 testing. TRICARE only covers COVID-19 tests that are medically necessary and ordered by a TRICARE-authorized provider. If someone has TRICARE For Life, learn how Medicare coverage of COVID-19 testing is changing.
• Telehealth: To help protect privacy, all providers must now use HIPAA-compliant telehealth platforms.
• Clinical Trials: Temporary coverage of National Institute of Allergy and Infectious Diseases–sponsored COVID-19 clinical trials ended April 10. If someone was enrolled in a covered trial on or before April 10, their care will be covered through the end of the trial.
• Skilled Nursing Facilities: A temporary waiver of the requirement for a three-day prior hospital stay before admission to a skilled nursing facility ended for new admissions after April 10.
Protect oneself from COVID-19
It’s still important to take steps to help protect oneself and others. Vaccines are still the most effective tool to prevent serious illness, long-term effects and death from COVID-19 — even if someone has had COVID-19 in the past.
Is everyone up to date with COVID-19 vaccines? As outlined in recently updated
CDC guidance:
• Everyone 6 years and older is up to date if they’ve received one updated (bivalent) Pfizer-BioNTech or Moderna COVID-19 vaccine, regardless of whether they’ve received any original COVID-19 vaccines. If someone is 65 or older, they may get a second dose of the updated vaccine.
• Children ages 6 months through 5 years should get one or more doses of the updated vaccine, depending on their age and which COVID-19 vaccines they’ve already received.
Go to the CDC website to learn more about COVID-19 vaccine recommendations and benefits of getting vaccinated. An individual’s health care provider can give guidance on when they should get the updated vaccine.
There are options for where someone can get an updated COVID-19 vaccine, including:
• Military hospitals, clinics and vaccination sites
• Local or state health department vaccination sites
• A civilian provider
• Pharmacies participating in the Federal Retail Pharmacy Program, participating pharmacies and vaccination sites, which can include local convenience store chains and grocery stores
A person can get updated COVID-19 vaccines at no cost. But they may have costs for an office visit or if they need follow-on care. Their out-of-pocket costs would be based on their TRICARE health plan.
To learn more about options for COVID-19 vaccines, check out COVID guidance for TRICARE beneficiaries. If someone has coverage questions, call that person’s TRICARE contractor.
