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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)

States: MN, ND, SD, WI, IA, NE

Testing Coverage (effective 02/04/2020 – 06/16/2020)

Medica Prime Solution and Advantage Solution will cover the cost of medically necessary COVID-19 diagnostic testing as determined by guidelines from the Centers for Disease Control and the Federal Drug Administration, and ordered by an appropriate medical professional. Provider services for that testing will also be covered at no cost to members if they see a network provider or an out-of-network provider who is Medicare eligible. This means the member's share of the cost will be waived for COVID-19 office visits, urgent care, walk-in retail health clinics, emergency room and outpatient facilities if member is being tested for COVID-19.

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 a hospital participating with their Medica network, when accessing extended absence and travel benefits, and in an emergency i.e. admission through an emergency room, if the provider/hospital is Medicare eligible, at no cost to members.

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)

State: MN

Testing Coverage (effective 02/04/2020 – 06/16/2020)

Medica Medicare Supplement (Signature Solution) will cover the cost of medically necessary COVID-19 diagnostic testing as determined by guidelines from the Centers for Disease Control and the Federal Drug Administration, and 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 Medicare Supplement (Select Solution) will cover the cost of medically necessary COVID-19 diagnostic testing as determined by guidelines from the Centers for Disease Control and the Federal Drug Administration, and 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.

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.

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 June 16, 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.

Yes, 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:

  • Medicare Prime Solution Plan members (COST)
  • Medicare 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, and 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 Medicare Prime Solution Plan members (COST)
  • Medicare 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, utilization of additional technologies such as FaceTime or Skype, and audio only, for most visits, when video is not available.

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:

  • Medicare Prime Solution Plan members (COST) (except Thrift, Core in NE, Premier in NE and Group retiree plans)
  • Medicare 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.




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Last Updated: April 2020

Date: 6/5/2020 7:23:06 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB01