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March 28, 2023

During the federal COVID-19 public health emergency (PHE), we temporarily expanded our benefit coverage to make it easier for members to access needed care. The PHE ends at 11:59 p.m. on May 11, 2023, and many of these expanded benefits will return to being covered under normal health plan benefits. That means any applicable cost-shares, such as copays and coinsurance, will apply.

Here’s a look at how the changes will affect Medicare members and how we’ll cover COVID-19 care and treatment moving forward:

• For members on a Preferred Provider Organization (PPO) plan, out-of-network services, including medical and dental, will be covered as out of network.

• For members on a Health Maintenance Organization (HMO) plan, out-of-network services, including medical and dental, won’t be covered. Referrals from a primary care provider to receive specialist care may be required.

• COVID-19 vaccinations, including boosters, will continue to be covered as preventive care at no cost if received from an in-network provider. Vaccinations administered by an out-of-network provider will include a cost-share.

• COVID-19 lab tests, if ordered by a provider, will include a cost-share, such as a copay or coinsurance.

• Medicare will no longer provide any free over-the-counter at-home COVID-19 tests. Purchases of these tests from pharmacies or other participating entities will be an out-of-pocket cost.

• We’ll continue to cover the cost of FDA-approved treatment prescribed by a provider for COVID-19. Treatments will be covered by normal health plan benefits, and cost-shares may apply.

• No changes are expected at this time for coverage of telehealth services.

Questions? Contact your Medicare sales representative.