COVID-19 vaccines from in-network providers are still covered.* You may receive a bill if you receive COVID-19 vaccines from an out-of-network provider. Refer to your plan documents for full coverage details.
*Exception: Members enrolled in grandfathered and retiree plans should check their plan documents to determine vaccine coverage.
OTC at-home test kits
OTC (over the counter) COVID-19 at-home test kits will no longer be covered.*
For Medicaid members, select OTC COVID-19 at-home test kits purchased with a prescription are covered through at least September 30, 2024. OTC COVID-19 at-home tests purchased without a prescription are not covered. Use the Medicaid Approved Drug List to see which tests are covered. FEHB members can still be reimbursed for OTC tests after May 11, 2023 by filling out this reimbursement form.
*If you are a MyPriority or employer-sponsored plan member with pharmacy benefits through Priority Health, and purchased OTC at-home test kits before May 11, 2023, you are still eligible for reimbursement by filling out this reimbursement form.
Tests ordered or administered by a health care professional
Medically necessary diagnostic COVID-19 testing will be covered as any other diagnostic testing. Members will be responsible for any applicable copays, coinsurance, deductibles, etc.
For Medicaid members, medically necessary diagnostic COVID-19 testing will be covered for free through September 2024. After that date, there may be a limit to the number of covered tests or nominal cost-sharing.
Pharmaceutical COVID-19 treatments are covered as long as they continue to be authorized by the Food and Drug Administration (FDA).*
*Members are responsible for any applicable copays, coinsurance, deductibles, etc. For coverage information, refer to the Approved Drug List.
Some flexibilities allowing provider offices to practice care virtually will end. For more information, contact your provider’s office to see if they will still be offering virtual care.