Individual + family plan COVID-19 FAQs

Get answers to common questions about individual and family plans and COVID-19. Find out about prevention, testing, treatment, vaccinations, coverage, and more.

Get information about no-cost at-home COVID-19 diagnostic tests kits. Learn more
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We’re here to make sure you’re in the know when it comes to COVID-19.

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Financial Assistance

My income is reduced. Do I qualify for additional help?

If your income has changed, you may be eligible for extra help paying your monthly health insurance premium and other health-related costs. Log into your Health Insurance Marketplace account to update to your income and see if you qualify for assistance.
 
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Testing

Is diagnostic testing for COVID-19 covered?

We’ll waive your copays, coinsurance and deductibles for medically necessary in-network COVID-19 diagnostic testing. This applies to testing that meets guidelines from Centers for Disease Control (CDC) and the Food and Drug Administration (FDA), and is ordered by an in-network medical professional. Testing isn’t covered as part of a return-to-work requirement, public surveillance program, or travel requirement.
 
These changes are retroactive to March 1, 2020, and will extend through April 30, 2022.
 

How can members order free at-home COVID-19 diagnostic test kits? 

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.

Are at-home OTC antigen COVID-19 diagnostic test kits covered?

Effective Jan. 15, 2022, and for the duration of the national public health emergency, Medica members enrolled in individual plans and commercial fully and self-funded plans have coverage for over-the-counter (OTC) FDA-authorized COVID-19 antigen tests without a prescription from a qualified health professional.

  • Coverage includes up to eight FDA-approved OTC COVID-19 antigen home tests for each member per month covered under a subscriber's plan.
  •  Tests can be obtained through a network pharmacy or mail order at no cost using your Medica ID card.* Tests should be brought to the pharmacy counter to be submitted through the claims process.
  •  If you purchase the test through a retailer (e.g., at the front register), you will be charged the full cost of the test and will need to submit a claim form to be reimbursed. Reimbursement will be $12 per OTC test.
  • Tests obtained at an out-of-network pharmacy or retailer are eligible for reimbursement at $12 per OTC test. Members will be required to submit a claim form to process reimbursement.
  • OTC tests purchased prior to Jan. 15, 2022 are not eligible for reimbursement.
  • Tests purchased to fulfill employer-directed testing requirements are not eligible for reimbursement.
    *If you paid out-of-pocket for your OTC antigen tests, you can complete and submit a Pharmacy Claim Submission form (Note: you don’t need to enter the NCPD/NPI or have the form signed by the pharmacy).
    Completed forms and receipt(s) can be submitted at Medica.com/SignIn, or mailed to the following address for reimbursement:


Express Scripts
ATTN: Commercial Claims
P.O. Box. 14711
Lexington, KY 40512-4711

Or you can fax your claim form and receipt(s) to 1-608-741-5475.

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

 

What is the difference between PCR and antigen COVID-19 diagnostic tests?

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.

Is antibody testing for COVID-19 covered?

Yes. We’ll waive your copays, coinsurance, and deductibles for Food and Drug Administration (FDA)-approved antibody tests after a suspected (not confirmed) COVID-19 diagnosis. An in-network provider must order the tests, and they must be medically needed. Testing isn’t covered as part of a return-to-work requirement, public surveillance program, or travel requirement.

Coverage for the antibody test applies both in-network and out-of-network. It includes office visits and other charges related to the antibody test when performed at in-network locations.

This coverage will extend through April 30, 2022.

 

Do I need to see a doctor in my network to get tested for COVID-19?

It depends on the state where you purchased your policy.

Iowa, Kansas, Missouri and Nebraska Policies:
You must see a network provider for coverage of COVID-19-related costs.

Oklahoma Policies:
You must see a network provider for coverage of COVID-19-related costs. If you visit an out-of-network provider, services will apply to out-of-network benefits.

Minnesota, North Dakota and Wisconsin Policies:
You can see any provider for coverage of COVID-19-related costs.

If I suspect I have COVID-19, how do I know if I’m eligible to get tested?

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

If I suspect I have COVID-19, how do I find a clinic that can test me?

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

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Treatment

Is treatment for COVID-19 covered?

We'll waive your copays, coinsurance, and deductibles for COVID-19 inpatient hospital care. These changes are retroactive to March 1, 2020, and will extend through September 30, 2021.

Will prior authorization requirements for care requests be waived?

Yes. Prior authorization isn’t required for admissions to long-term care facilities, acute inpatient rehabilitation, and skilled nursing and home health care facilities. This change is in effect through April 30, 2022.

Do I need to see a doctor in my network to get treatment for COVID-19?

It depends on the state where you purchased your policy.

Iowa, Kansas, Missouri and Nebraska Policies:
You must see a network provider for coverage of COVID-19-related costs.

Oklahoma Policies:
You must see a network provider for coverage of COVID-19-related costs. If you visit an out-of-network provider, services will apply to out-of-network benefits.

Minnesota, North Dakota and Wisconsin Policies
You can see any provider for coverage of COVID-19-related costs.

Will early refills for prescriptions be authorized?

Maybe. If you have prescription benefits with us, 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.

Can I get a 90-day supply of my prescription medication(s)?

Yes, members can request a 90-day supply of some long-term medications used to treat chronic conditions. At this time, we’re not authorizing requests to fill medications that are not eligible for 90-day refills.

How can I get prescriptions without leaving home?

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

Are virtual care services available?

Yes, virtual or telehealth visits are covered as part of your plan. Sign in to find a provider in your network.

We’ve expanded telehealth visit availability to include visits that:

  • Are from your home
  • Use technologies such as FaceTime or Skype
  • Use audio only when video isn’t available

Keep in mind:

  • Virtual visits aren’t for emergencies
  • Most providers are available 24 hours a day, 7 days a week
  • You don’t need an appointment
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Vaccination

What can you tell me about the vaccine for COVID-19?

Get answers to frequently asked questions about COVID-19 vaccine coverage and availability in this PDF.

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Get Coverage

I don’t have health insurance coverage. Can I sign up now?

It depends on your state of residence.

Minnesota Residents:
The MNsure Health Insurance Marketplace announced a limited Special Enrollment Period that will allow uninsured individuals to get covered. You must enroll in coverage by April 1. Coverage will start on April 1. Visit MNsure for more information.

Iowa, Kansas, Missouri, Nebraska, North Dakota, Oklahoma, and Wisconsin Residents: 
At this time, you can only enroll in coverage if you experience a qualified life event. Examples include losing your employer-sponsored coverage, having a baby, or moving outside your plan’s service area.

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