Skip to Main Content
Members

« Return to COVID-19 Resources page

Frequently Asked Questions About COVID-19

For Medica Medicare Members

 

Medica Prime Solution (COST) and Medica Advantage Solution (HMO, HMO-POS, PPO)

Including Medica Advantage Solution PartnerCare (HMO I-SNP) 

Testing Coverage (effective 02/04/2020 – 10/31/2020)

Medica Prime Solution and Advantage Solution will cover the cost of medically necessary 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 medical professional. Provider services for that testing will also be covered at no cost to members if they see a provider who is Medicare eligible. This means the member's share of the cost will be waived for COVID-19 testing in office visits, urgent care, walk-in retail health clinics, emergency room and outpatient facilities if the member is being tested for COVID-19.

Medica will also cover the cost for FDA-approved antibody tests after a suspected (not confirmed) COVID-19 diagnosis. Tests must be ordered by a medical professional and considered medically necessary.* Coverage for the antibody test will extend to office visits and other charges related to the antibody test when performed in-network. This new coverage will extend through October 31, 2020.

*Not covered as part of a return to work request.

Treatment Coverage (effective 03/01/2020 – 09/30/2020)

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 Advantage Solution group retiree plans will cover the cost of COVID-19 treatment if the provider/hospital is Medicare eligible, at no cost to members.


Medica Medicare Supplement (Medigap) 

Testing Coverage (effective 02/04/2020 – 10/31/2020)

Medica Medicare Supplement (Signature Solution) will cover the cost of medically necessary COVID-19 diagnostic testing (COVID-19 infection). 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 medical professional. Provider services for that testing will also be covered at no cost to members if they see a provider who is Medicare eligible. This means the member's share of the cost will be waived for office visits, urgent care, walk-in retail health clinics, emergency room and outpatient facilities when the member is being tested for COVID-19.

Medica will also cover the cost for FDA-approved antibody tests after a suspected (not confirmed) COVID-19 diagnosis. Tests must be ordered by a medical professional and considered medically necessary.* Coverage for the antibody test will extend to office visits and other charges related to the antibody test when performed in-network. This coverage will extend through October 31, 2020.

*Not covered as part of a return to work request.

Medica Medicare Supplement (Select Solution) will cover the cost of medically necessary 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 medical professional. Provider services for that testing will also be covered at no cost to members if they see a provider who is Medicare eligible. This means the member’s share of the cost will be waived for COVID-19 testing in office visits, urgent care, walk-in retail health clinics, emergency room and outpatient facilities if member is being tested for COVID-19.

Medica will also cover the cost for FDA-approved antibody tests after a suspected (not confirmed) COVID-19 diagnosis. Tests must be ordered by a medical professional and considered medically necessary.* Coverage for the antibody will extend to office visits and other charges related to the antibody test when performed in-network. This coverage will extend through October 31, 2020.

*Not covered as part of a return to work request.

Treatment Coverage (effective 03/01/2020 – 09/30/2020)

Medica Medicare Supplement (Signature Solution) will cover the cost of COVID-19 treatment in a hospital setting, as long as the provider/hospital is Medicare eligible, at no cost to members.

Medica Medicare Supplement (Select Solution) will cover the cost of COVID-19 treatment in a hospital that is participating with their Medica contracted network, at no cost to members.

Home tests for COVID-19 that are FDA-approved, ordered by a practitioner and medically necessary are eligible for coverage, except when done for a return to work or public surveillance.

Yes. If you have a Medica Advantage Solution plan, all in-office, in-network primary care, specialist or behavioral health office visit copays will be waived from June 1- September 30, 2020. Medica is committed to the health and well-being of you and your family. That’s why we recommend you continue to get the care you need while following safety protocols – wear a mask and wash your hands often. Of course, if you have challenges getting to the office or clinic, telehealth is an option, but does continue to come with a copay.

Medica will cover costs whether Medicare members see an in-network or out-of-network provider.

Yes. Prior authorization requirements will not be required for admissions to long-term care facilities, acute in-patient rehabilitation and skilled nursing and home health care facilities. This change will extend through September 30, 2020.

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.

Maybe. Members can request a 90-day supply of some long-term medications used to treat chronic conditions. Medica, at this time, 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.

View details on your member page

Applies to:

  • Medica Prime Solution Plan members (COST)
  • Medica Advantage Solution (HMO, HMO-POS & PPO)

Your options include:

  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. To learn more and request mail order delivery of your medications, go to your member pages. Under the Pharmacy or My Prescriptions sections, locate the mail order services section for details on how to get started.

    View details on your member page

  2. Retail pharmacy home delivery 

    Many retail pharmacies will mail your prescription to your home, free of charge. Check with your pharmacy for details.

Applies to:

  • Most Medica Prime Solution Plan members (COST)
  • Medica Advantage Solution (HMO, HMO-POS & PPO)

Note: Some home delivery requests may require an in-person office visit and a new prescription from a prescriber.

Yes, virtual visits are covered as part of your plan. Those may be with a network provider or through Virtuwell.

Medica has expanded the availability of telehealth visits to include visits from a member’s home. You can use additional technologies such as FaceTime or Skype. When video is not available, you may use audio only for most visits.

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 COVID-19 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

Applies to:

  • Medica Prime Solution Plan members (COST) (except Thrift, Core in NE, Premier in NE and Group retiree plans)
  • Medica Advantage Solution (HMO, HMO-POS & PPO) (except Group retiree plans)

Visit Virtuwell

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

If your primary care provider recommends that you be tested, they will send you directly to a testing center.




Y0088_55719
Last Updated: July 2020

Date: 8/6/2020 7:55:26 PM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB01