Medicaid plan COVID-19 FAQs

Get answers to common questions about COVID-19 coverage.

Beginning Jan. 18, 2022, each U.S. household may order up to four free at-home antigen COVID-19 test kits from the federal government. The free test kits may be ordered at https://www.covidtests.gov/ and orders will ship for free.

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.

 

A PCR (or Polymerase Chain Reaction) test is used to detect genetic material from a specific organism, such as a virus. PCR tests detect viral RNA. PCR tests are sent to a lab for the assessment of the test. Results generally take a couple of days.

Antigen tests, also called rapid diagnostic tests, detect specific proteins on the surface of the coronavirus. Antigen tests can be purchased through a retailer and done at home. Results may come back in as little as 15 to 45 minutes.
 

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 July 31, 2022.

*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. This change is through April 30, 2022.

COVID-19 monoclonal antibody treatment is covered with no member cost through July 31, 2022. Treatment must be medically necessary and ordered by an in-network medical professional. Coverage includes medications under emergency use authorization by the FDA including Eli Lilly (Bamianivimab and Bamlanivimab & Estesevimab) and Regeneron (Casirivimab and Imdevimab). Recommendations for these products are frequently changing. Speak with your provider about current treatment recommendations. 

COVID-19 oral treatment drugs will be covered during the national public health emergency. Members will not be responsible for the ingredient cost or the dispensing fee of the COVID-19 oral treatment drug. After the national public health emergency ends, members will be responsible for their normal cost share.

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.

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)

 

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.

Keep in mind:

  • Not for emergencies
  • Most providers are available 24 hours a day, 7 days a week
  • No appointment needed

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-RideSM 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.


Medica DUAL Solution® and Medica AccessAbility Solution® Enhanced are health plans that contract with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. Enrollment in Medica DUAL Solution and Medica AccessAbility Solution Enhanced depends on contract renewal.

 

Y0088_1000975 a
H2458_1000975 a Approved
Last Updated: April 2022
 
X
We use cookies to ensure you get the best experience on our website. Cookie Policy 
OK