On January 30, 2023, the Administration announced a Statement of Administration Policy declaring their intent to terminate the COVID-19 national emergency and public health emergency (PHE) on May 11, 2023. 

Subsequent to the PHE termination, beginning August 1, 2023, we will modify our Ambetter Health benefit coverage on certain COVID-19 related services. This includes changes to cost-sharing requirements for various COVID-19 testing, screening, and vaccination services. Please refer to the following Q&A’s for more information. 

Do you have any questions about this PHE termination 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 Health plan will cover the cost of COVID-19 tests and the associated physician’s visit.  

Beginning August 1, 2023, your plan’s copayment, coinsurance and/or deductible cost- sharing requirements will apply for medically necessary COVID-19 diagnostic testing and/or medical screening services.

Beginning August 1, 2023, your plan will no longer cover COVID-19 Over the Counter and/or Home Testing Kits.

Yes, medically necessary antibody testing is covered when ordered and/or referred by a licensed health care provider.

Beginning August 1, 2023, your plan’s copayment, coinsurance and/or deductible cost- sharing requirements will apply on COVID-19 antibody tests.

When services are performed by an In-Network, participating provider, COVID-19 vaccines will be covered at no cost to you. You do not need to obtain a prior authorization for your vaccines when services are performed by an In-Network, participating provider. 

Beginning August 1, 2023, general plan requirements will be re-enforced for services that are performed by an Out-of-Network, non-participating provider. Members will incur out-of-pocket costs for COVID-19-related services, including costs associated with Out-of-Network services. Refer to your plan documents for more details on Out-of-Network coverage options and/or contact Member Services for more information.

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.

Contact your Primary Care Physician or local In- Network Pharmacy to confirm your eligibility and to schedule an appointment for your booster. You should present your COVID-19 Vaccination Record Card.

Yes. Please contact Member Services. 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.

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 to 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. 

Please refer to your plan’s policy provisions or contact Member Services for more information.

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

CVS Mail Order

As an Ambetter Health 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.

You may receive free masks (N95 respirators) at a participating location near you by visiting the Center for Disease Control and Prevention’s Find Free Masks site or calling 1-800-232-0233 (TTY 1-888-720-7489).