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Medicare plan COVID-19 FAQs
Medica Prime Solution (COST), Medica Advantage Solution (HMO-POS, PPO), including Medica Advantage Solution PartnerCare (HMO I-SNP), and Medica Advantage Solution with CHI Health (HMO)
How is COVID-19 diagnostic testing covered?The following lab testing coverage is effective from Feb. 4, 2020 to January 31, 2023:
Medica covers rapid diagnostic tests and standard nasal and saliva diagnostic tests. This applies to testing that meets Centers for Disease Control (CDC) and the Food and Drug Administration (FDA) guidelines, and is ordered by an appropriate medical professional.*
Are at-home over-the-counter (OTC) antigen COVID-19 antigen test kits covered?
Starting April 4, 20221, CMS will cover up to eight2 over-the-counter COVID-19 antigen tests each month at no cost.
Tests can be obtained through a network pharmacy at no cost.3 Tests should be brought to the pharmacy counter and billed by the pharmacy to Medicare, not Medica.
A list of participating pharmacies can be found here. There is no reimbursement option if you obtain a test from a non-network location.
Applies to all individuals with Medicare Part B, including members on Medicare Advantage plans.
*Not covered as part of a return to work requirement, public surveillance program or travel requirement.
1Tests purchased prior to April 4th are not eligible.
2If a test kit includes multiple tests, the benefit is for eight individual tests. Ex: If a kit includes four tests, you may obtain two kits each month.
3If you paid out-of-pocket for your OTC antigen tests at a network pharmacy, you will need to submit a request to get reimbursed for your costs.
What is the difference between PCR and antigen COVID-19 diagnostic tests?
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 inpatient treatment for COVID-19 covered?
Inpatient Treatment Coverage (effective February 4, 2020 to September 30, 2021)
Medica Prime Solution and Advantage Solution individual plans will cover the cost of COVID-19 treatment at no cost to members in these situations:
- In a hospital participating with their Medica network
- When accessing extended absence and travel benefits, or in an emergency (i.e. admission through an emergency room)
- If the provider/hospital is Medicare eligible
Medica will cover the cost of COVID-19 treatment if the provider/hospital is Medicare eligible, at no cost to members.
Yes. Prior authorization isn’t required for admissions to long-term care facilities, acute inpatient rehabilitation, and skilled nursing and home health care facilities. Effective through April 30, 2022.
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.
Maybe. Members can request a 90-day supply of some long-term medications used to treat chronic conditions. At this time, we will not authorize requests to fill medications that are not eligible for 90-day refills.
90-day Prescription Services
To reduce your trips to the pharmacy, you can get up to a 90-day supply at one time from a participating retail pharmacy location.
- Medica Prime Solution Plan members (COST)
- Medica Advantage Solution (HMO, HMO-POS, and PPO)
Learn more about 90-day refill options.
1. Home delivery (mail-order) prescription services
Mail order home delivery of your prescriptions is available with most Medica plans. This convenient service also can save you money.
Learn more and request mail order delivery.
2. Retail pharmacy home delivery
Many retail pharmacies will mail 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.
- Most Medica Prime Solution Plan members (COST)
- Medica Advantage Solution (HMO, HMO-POS, and PPO)
Yes. Virtual or telehealth visits are covered as part of your plan. Those may be through virtuwell or with another network provider. Virtuwell is an online clinic staffed by nurse practitioners who help treat common non-emergencies like pink eye, common colds, earaches, and more.
We've expanded the availability of telehealth visits to include visits that:
- Are from your home
- Use technologies such as FaceTime or Skype
- Use audio only when video is not available
Virtual staff also offer a free test to help you determine if your symptoms resemble COVID 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:
- Virtual visits aren't for emergencies
- Most providers are available 24 hours a day, 7 days a week
- You don't need an appointment
- Medica Prime Solution Plan members (COST) (except Thrift, Core in NE, Premier in NE, and Group retiree plans)
- Medica Advantage Solution (HMO-POS and PPO) (except Group retiree plans)