Coronavirus Coverage | Ambetter from Coordinated Care


What You Need to Know About Coronavirus

Symptoms, Testing, and Treatment

COVID-19 is a respiratory illness that is caused by a new virus called a coronavirus, which has become a public health emergency. Coronavirus illness 2019 (COVID-19) is an emerging illness. However, there are steps you can take to prevent the spread of coronavirus and stay healthy.

The symptoms of coronavirus include mild to severe respiratory symptoms. Symptoms include fever, cough, and shortness of breath, and lower respiratory illness. Other symptoms include fatigue, mucus production, and muscle aches. Some individuals have also experienced gastrointestinal symptoms, such as diarrhea and nausea, prior to developing respiratory symptoms. It may be contagious before a person begins showing symptoms.

The CDC’s "Coronavirus Self-Checker” can provide you with information about seeking appropriate medical care based on COVID-19 related symptoms; however it is not intended to diagnose COVID-19. People who think they may have been exposed to COVID-19 should contact their healthcare provider immediately.

Symptoms may appear 2 – 14 days after exposures. However, infected individuals can be contagious before symptoms arise (i.e. from an asymptomatic individual). 

Influenza (the flu), a contagious respiratory illness caused by the influenza viruses (Type A and Type B), has high activity in the United States in the Fall/Winter months. Everyone 6 months of age and older should get a flu vaccine annualy.

If you have been exposed or begin showing symptoms of the coronavirus or flu, contact your healthcare provider or health department immediately. We would be happy to help you locate an in-network provider.

If you are unsure if you have been exposed to or at-risk of being infected with COVID-19 (coronavirus), scheduling a virtual care visit with a provider is a good option for non-urgent care to limit potential exposure in a physician’s office or other healthcare facility. Due to a high demand for virtual health visits at this time, please anticipate that there may be longer than usual wait times.

Emergency warning signs for COVID-19 include, but are not limited to: trouble breathing, persistent pain or pressure in the chest, blueish lips or face, new confusion or inability to arouse. If you are experiencing any of these warning signs, you should seek immediate medical attention. Contact your healthcare provider if you have symptoms which are worsening or concerning to you.

To receive the fastest support, you can contact Teladoc by mobile App or through the web to request a virtual visit. You will also be able to see a wait time estimator to help you to anticipate when a provider will call you back. You can download the Teladoc app on the App Store or Google Play. You can also call Teladoc to request a virtual visit. If there is a wait, you can request a callback from a service representative to request a visit, so you don’t need to stay on hold.

If you haven’t used Teladoc before, you can set up an account and share your medical history before requesting a visit to make the process go quicker. You can set up your account on the Teladoc app or on their account set up page. If you need assistance setting up your account, you can call Teladoc for help.

We encourage members to call the Nurse Advice Line with questions about symptoms of illness or other health-related issues. Registered nurses are available through the Nurse Advice Line 24 hours a day, 7 days a week, 365 days a year. However, due to a high demand at this time, please anticipate that there may be longer than usual wait times when you call the Nurse Advice Line. As a reminder, the Nurse Advice Line cannot answer general member services questions, providing plan benefits or making provider referrals, including questions related to COVID-19 coverage and benefits.

Medically necessary COVID-19 diagnostic testing and/or medical screening services and the associated physician’s visit will be covered when ordered, referred and/or performed in the following locations:

  • Physician’s/practitioner’s office
  • Independent laboratory/diagnostic facility
  • Urgent care facility
  • Emergency department facility

If you have been exposed or are showing symptoms of the coronavirus or flu, contact your healthcare provider or health department immediately. 

If you are unsure if you have been exposed to or at-risk of being infected with COVID-19 (coronavirus), scheduling a virtual care visit with a provider is a good option for non-urgent care to limit potential exposure in a physician’s office or other healthcare facility. However, due to a high demand for virtual health visits at this time, please anticipate that there may be longer than usual wait times.

We all have a role to play in protecting our communities and families from the spread of coronavirus. There are steps you can take to prevent the spread of coronavirus and stay healthy. If you have been exposed or begin showing symptoms of the coronavirus or flu, contact your healthcare provider or health department immediately.

You can also follow these tips to prevent infection:

  • Wash your hands thoroughly and frequently. Use soap and water for at least 20 seconds.
  • Use an alcohol-based hand sanitizing rub (must contain at least 60 percent alcohol).
  • Wear a face covering/mask when in public and/or around others who do not live in your home.
  • Cover your mouth when you cough or sneeze by coughing/sneezing into your elbow.
  • Promptly dispose of tissues in a wastebasket after use.
  • Clean public surfaces thoroughly.
  • Stay home when you are sick.
  • Avoid shaking hands.
  • Avoid close contact with people who are sick.
  • Get a flu vaccine annually

Older adults, individuals with underlying medical conditions, such as heart disease, lung disease, diabetes, asthma, kidney disease, severe obesity, and those with weakened immune systems (due to medications or underlying illness) are at higher risk for complications from COVID-19 illness.

Yes, Ambetter members will be able to refill prescriptions prior to the refill date.

As an Ambetter member, you can maximize your pharmacy benefits by filling your prescriptions with CVS Caremark Mail Service Pharmacy, the only in-network mail order pharmacy. Eligible members pay only 2.5x* their regular copay for a three-month fill. Delivery is free and can be to your home, workplace, or any address you choose.

Two easy ways to get started:

  1. Call your doctor and ask them to send a new 90-day prescription to CVS Caremark Mail Service Pharmacy.
  2. Or, request a new 90-day prescription at Caremark.com.

*2.5x copay is only applicable for three-month mail order fills from CVS Mail Order. All other three-month mail order fills will be subject to the standard 3x copay.

There is now a vaccination available that will give you the best chance of protecting yourself and your loved ones from getting COVID-19. Some COVID-19 vaccines will have two doses a few weeks in between each shot. You will get a COVID-19 Vaccination Reminder Card that will help you keep track of which vaccine you receive and when to get a second dose, if needed. If you receive a vaccine that requires two doses, it is important to get both doses.

The vaccine is being administered to different populations in a tiered approach. When you are able to get the vaccine, call your doctor with any questions and ask when you can make an appointment with them or at your local pharmacy. Or, find out where to get your vaccine at cdc.gov/coronavirus/2019-ncov/vaccines or  vaccinefinder.org.

While it is not a requirement, getting your COVID-19 vaccine will give you the best chance of protecting yourself and your loved ones from getting COVID-19 in the future.

Even if you have already had COVID-19, you should still get the vaccine.  It may be possible to be infected more than once so getting the vaccine is a safe choice. 

Currently, the Pfizer-BioNTech vaccine is recommended for people ages 16 and older. The Moderna and Johnson & Johnson vaccines are recommended for those ages 18 and older. 

According to the CDC, people who are pregnant and part of a group to receive the COVID-19 vaccine may choose to be vaccinated. If you have questions about getting the vaccine, it is recommended to discuss with your doctor to make an informed decision. 

There is not definitive evidence that the vaccine can prevent asymptomatic infection, or prevent spreading COVID-19 if you are asymptomatic. Even with a vaccine, there is a possibility that you could become infected, but not have symptoms. This could get loved ones around you sick.

The CDC announced on March 8 that fully vaccinated Americans can discontinue masking and social distancing with other fully vaccinated people indoors in small groups. Or, visiting with unvaccinated people from a single household who are at low risk for severe COVID-19 disease indoors.

Fully vaccinated is considered two weeks past final dose, meaning the second dose of the Moderna or Pfizer mRNA vaccine, or, two weeks past the single dose Johnson & Johnson vaccine. 

It is important to continue to social distance, wear a mask, and continue proper handwashing when visiting unvaccinated people from multiple households. Or, when visiting unvaccinated people at increased risk for severe COVID-19.

It is also important to wear a mask and practice social distancing when in public places, such as the gym or a restaurant, as the chance of transmission is higher with multiple non-vaccinated persons.

 If you are fully vaccinated and have a known exposure to someone with COVID-19, the CDC says that you may refrain from quarantine and testing if you are asymptomatic. It is recommended to continue to monitor for symptoms for 14 days. 

The safety of the COVID-19 vaccine is a top priority! The Food and Drug Administration (FDA) carefully reviews all safety data from clinical trials and authorizes emergency vaccine use only when the expected benefits outweigh potential risks. COVID-19 vaccines were tested in large clinical trials to make sure they meet safety standards.

You may run a fever after you get the vaccine. This is normal as your body builds immunity and fights off future COVID-19 exposures. You may feel sick after getting vaccinated. You could develop a fever, headache or body aches. This is your body reacting to the vaccine, which is a normal response. It is important to know that it is impossible to get COVID-19 from the vaccine. The vaccines currently in use and others being developed do not contain a live virus.

Cost and Coverage

On January 7, 2021, HHS Secretary Alex Azar renewed the COVID-19 Public Health Emergency (PHE). This extends flexibilities and funding tied to the PHE to continue until April 21, 2021.

With this renewal the various testing, screening, billing, and telehealth coverages that were implemented in response to the COVID-19 PHE in 2020 will be extended to our members. This extension will go through April 21, 2021, until the PHE is either terminated or extended again. This extension does not affect coverages that had already been made effective through December 31, 2020.

Do you have any questions about this extension or the covered benefits impacted by it? Please contact Member Services.

Yes, when medically necessary diagnostic testing is ordered and/or referred by a licensed health care provider, your Ambetter plan will cover the cost of COVID-19 tests and the associated physician’s visit. Your plan’s copayment, coinsurance and/or deductible cost-sharing requirements will be waived for medically necessary COVID-19 diagnostic testing and/or medical screening services.

 

Yes, when medically necessary antibody testing is ordered and/or referred by a licensed health care provider, your Ambetter plan will cover the cost of COVID-19 antibody tests. Your plan’s copayment, coinsurance and/or deductible cost-sharing requirements will be waived on COVID-19 antibody tests.  

No, our Ambetter plans will not require prior authorization, prior certification, prior notification and/or step therapy protocols for COVID-19 diagnostic testing and medical screening services, when medically necessary services are ordered and/or referred by a licensed health care provider.

No, your Ambetter plan will cover medically necessary COVID-19 diagnostic testing and/or medical screening services at no charge to you, when such services are ordered and/or referred by a licensed health care provider. Your plan’s copayment, coinsurance and/or deductible cost-sharing requirements will be waived for medically necessary COVID-19 diagnostic testing and/or medical screening services along with the associated physician’s visit.

Yes, your plan will cover medically necessary COVID-19 treatment related services consistent with benefit coverage provisions of your policy for treatment of an illness. We are committed to ensuring access to COVID-19 treatment services in accordance with federal and state law.

No, our Ambetter plans will not require prior authorization, prior certification, prior notification and/or step therapy protocols for COVID-19 treatment, when services are ordered and/or performed by a licensed health care provider.

Yes. You will be responsible for your plan’s general copayment, coinsurance and/or deductible cost-sharing requirements for COVID-19 treatment and/or treatment related services.  

Ambetter will continue to cover COVID-19 testing, screening and vaccinations at no charge to you.

Yes, your plan utilizes Teladoc to provide telehealth services. All telehealth consults are now screened for COVID-19 symptoms and risk factors. Teladoc providers will evaluate your symptoms and contact history to assess your COVID-19 risk, and then help guide you through the next steps for care and testing, if needed. We are also encouraging members use telehealth visits for non-urgent health issues. If you haven’t used Teladoc before, you can visit their website or download the mobile App to get started. You can download the Teladoc app on the App Store or Google Play.

In addition to Teladoc, you may also be able to set up a telehealth consultation directly with your primary care provider. You can reach out to your primary care provider or their office to see what kind of virtual care options are available to you. We are temporarily waiving prior authorization for in-network telehealth services.

Yes. You will be responsible for your plan’s general copayment, coinsurance and/or deductible cost-sharing requirements when you have a telehealth visit with a provider. 

Ambetter will continue to cover COVID-19 testing, screening and vaccinations at no charge to you.

Yes. Save Money and Get Your Prescriptions Delivered to Your Door!

CVS Mail Order

As an Ambetter member, you can maximize your pharmacy benefits by filling your prescriptions with CVS Caremark Mail Service Pharmacy, the only in-network mail order pharmacy. Eligible members pay only 2.5x* their regular copay for a three-month fill. Delivery is free and can be to your home, workplace, or any address you choose.

Two easy ways to get started:

1.  Call your doctor and ask them to send a new 90-day prescription to CVS Caremark Mail Service Pharmacy.

2.  Or, request a new 90-day prescription at Caremark.com.

*2.5x copay is only applicable for three-month mail order fills from CVS Mail Order. All other three-month mail order fills will be subject to the standard 3x copay.

No. The COVID-19 vaccine will be covered at no cost to you. You do not need to obtain a prior authorization for your vaccine.

Please call the administering facility/provider you received your first dose from to ask about your vaccine information and verify your second appointment/location. 

The provider should have scheduled a second appointment with you at the same facility when you received the first dose. However, you can receive your second dose from another provider/facility and you should present your COVID-19 Vaccination Record Card.

Yes. Please contact member services at 1-877-687-1197 (TTY/TDD 1-877-941-9238). You may be able to receive transportation by contacting United Way-211 to access local community resources for transportation, which may include the Lyft Vaccine Alliance Program.  

Payment and Financial

Ambetter understands you may be experiencing financial difficulty at this time. If you’ve experienced an income change or job loss, we recommend that you visit https://www.wahealthplanfinder.org/ or call 1-855-923-4633 (TTY: 1-855-627-9604) to update your income information. Updating your information could affect the amount of your tax credit, possibly lowering your monthly premium.

If you’ve experienced financial hardship or job loss, you may qualify for additional annual premium tax credit. Visit WAHealthplanfinder.org or call at 1-800-318-2596 (TTY: 1-855-889-4325) to update your income information. Updating your information could affect the amount of your tax credit, possibly lowering your monthly premium.

If you’ve experienced financial hardship or job loss, please visit WAHealthplanfinder.org or call at 1-800-318-2596 (TTY: 1-855-889-4325) to update your income information. Updating your information could affect the amount of your tax credit, possibly lowering your monthly premium. If you enrolled with a broker, they can also help update your information.

You may also be eligible for an Economic Impact Payment through the Federal government’s Coronavirus Tax Relief program. For more information, visit the IRS Coronavirus special section.

If you are in need of additional support right now, you can find programs in your area through the Aunt Bertha online platform. Aunt Bertha is a free tool that makes it easy to find and apply for assistance program. You can search for free or reduced cost services available in your zip code -including food, housing, job training, financial assistance and much more.

Social and Emotional Support

Yes, mental health services are a covered benefit. Visit your online member account to understand any costs associated with mental health specialist visits, specific to your health plan. To find mental health professionals near you, search for “Behavioral Health” in the Provider Search tool.

Through Ambetter Telehealth’s partner, Teladoc, you can talk to a therapist or psychiatrist.

To speak with a mental health professional, you will be prompted to schedule an appointment time. Visit the Teladoc website or download the mobile app from the Apple or Google Play app stores to get started.

There is no co-pay associated, however, coinsurance and deductible may apply to some plans for the session. Visit your online member account to understand any costs associated with mental health specialist visits, specific to your health plan.

We encourage members to take care of their body. Take deep breaths, stretch or meditate. While observing social distancing, connect with other through email, video chats, phone, texting, etc. Share your concerns and how you are feeling with a friend or family member. Maintain healthy relationships and a sense of hope and positive thinking. For more information, see the CDC's suggestions for mental health and coping during COVID-19.

If you are in need of additional support right now, you can find programs in your area through the Aunt Bertha online platform. Aunt Bertha is a free tool that makes it easy to find and apply for assistance program. You can search for free or reduced cost services available in your zip code - including food, housing, job training, financial assistance and much more.

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Healthcare is essential. Ambetter can help.

Our members’ health is important to us, now and always. That’s why you can count on us to cover COVID-19 testing and treatment. And if you’ve lost access to insurance, we want to help you get the coverage you need.

Because protecting peoples’ health is why we’re here, and it’s what we’ll always do.