Medicaid plan COVID-19 FAQs

We are covering the cost for medically necessary in-network and out-of-network COVID-19 diagnostic testing. This applies to testing that meets guidelines from Centers for Disease Control and the Food and Drug Administration (FDA), and is ordered by an appropriate in-network medical professional.* This change was effective as of March 19, 2020, but may apply to testing and treatment that occurred prior to that date. Further details about retroactive coverage will be announced later. The change will end when the national public health emergency is declared over.

*Not covered as part of a return to work requirement, public surveillance program, or travel requirement.

Home tests for COVID-19 that are FDA-authorized, ordered by a practitioner and medically necessary are eligible for coverage, except when done for a return to work requirement, public surveillance program, or travel requirement.

As of January 1, 2022 Medica members enrolled in a Medicaid plan have coverage for over-the-counter (OTC) FDA-authorized COVID-19 antigen tests with a prescription from a qualified health professional, including a pharmacist.
• Coverage includes up to eight FDA-approved OTC COVID-19 antigen home tests per 30 days.  Note that some kits contain more than one test per kit.  The limit is on the number of tests and not the number of kits or packages.  
• Tests can be obtained through a network pharmacy at no cost using your Medica ID card.* Tests should be brought to the pharmacy counter to be submitted through the pharmacy claims process.
• OTC tests purchased prior to January 1, 2022, or purchased without a valid prescription, are not eligible for reimbursement.

A listing of FDA-approved Emergency Use Authorization (EUA) COVID-19 antigen tests can be found on the FDA's website.

Yes. We are covering the cost for Food and Drug Administration (FDA)-approved antibody tests after a suspected (not confirmed) COVID-19 diagnosis. Tests must be ordered by an in-network medical professional and medically necessary.* Coverage will include office visits and other charges related to the antibody test when performed at in-network locations. Coverage is through April 30, 2023.

*Not covered as part of a return to work requirement, public surveillance program, or travel requirement.

Get answers to your COVID-19 vaccine coverage and availability FAQs (PDF) 

We are covering the cost for in-network COVID-19 inpatient hospital care. The change will end when the national public health emergency is declared over.

Yes. Prior authorization is not required for admissions to long-term care facilities, acute inpatient rehabilitation and skilled nursing and home health care facilities. Effective April 30, 2023.

Maybe. If you have prescription benefits with Medica, and your medication needs to be filled early, submit your refill request to your pharmacy. They will determine if your prescription can be filled early.

Yes, members with 90-day prescription services covered by their plan can continue to request a 90-day supply of long-term medications used to treat chronic conditions.

Filling a 90-day supply of a medication you know you will need may reduce your trips to the pharmacy. You can talk with your prescriber or pharmacist about 90-day prescription services available for your medications.

Your options include:

1. Express Scripts Home Delivery (mail order) Prescription Services
   
   Mail order home delivery of your prescriptions may be available with your plan. This service delivers your medications right to your home. Go to your member pages under the My Prescriptions section for information about mail order services and how to get started.
   
   View member pages
   
   Applies to:
   • Medica DUAL Solution® (HMO D-SNP), Minnesota Senior Health Options (MSHO)
   • Medica AccessAbility Solution® Enhanced (HMO D-SNP), Special Needs BasicCare Special Needs Plan (SNBC SNP)


2. Retail pharmacy home delivery
   Many retail pharmacies will mail or deliver your prescription to your home free of charge. Check with your pharmacy for details.
   NOTE: Some home delivery requests may require an in-person office visit and a new prescription from a prescriber.

Yes, virtual or telehealth visits are covered as part of your plan. Those may be with a network provider or through virtuwell.

We expanded the availability of telehealth visits to include:

• Visits from your home
• Visits using additional technologies such as FaceTime or Skype
• Visits using audio only when video is not available

Virtuwell.com

Virtuwell is an online clinic staffed by nurse practitioners who help treat 60 common non-emergencies like pink eye, common colds, ear aches and more. Staff also offer a free test to help you determine if your symptoms resemble coronavirus symptoms. Your visit starts with a quick online interview before a nurse practitioner reviews your case. The service costs $0 and often takes less than 30 minutes.

Call your primary care provider if you have a cough, fever or shortness of breath to find out if you meet testing criteria.

If your primary care provider recommends that you be tested, you may be sent directly to a testing center.

Your primary care provider will provide you details of how to care for yourself at home and what to do if your condition changes. If you have questions about those instructions you can call your clinic or NurseLine by HealthAdvocate™ 24/7 toll free at 1-866-715-0915 (TTY: 711).

If you don't have access to transportation, our Provide-A-Ride^SM program can help you. You may receive health care, including COVID-19 testing, dental care and other kinds of necessary medical visits. We recommend calling ahead to your health care provider or doctor before seeking medical treatment.

Provide-A-Ride
Toll free 1-888-347-3630  (TTY: 711)
Monday – Thursday, 8 a.m. to 5 p.m.
Friday, 9 a.m. to 5 p.m.