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We're here to make sure you're in the know when it comes to COVID-19.
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My income is reduced. Do I qualify for additional help?
If your income has changed, you may be eligible for extra help paying your monthly health insurance premium and other health-related costs. Log into your Health Insurance Marketplace account to update to your income and see if you qualify for assistance.
Is diagnostic testing for COVID-19 covered?
We'll waive your copays, coinsurance and deductibles for medically necessary in-network COVID-19 diagnostic testing. This applies to testing that meets guidelines from Centers for Disease Control (CDC) and the Food and Drug Administration (FDA), and is ordered by an in-network medical professional. Testing isn't covered as part of a return-to-work requirement, public surveillance program, or travel requirement.
These changes are retroactive to March 1, 2020, and will extend through the public health emergency which is set to expire on May 11, 2023.
Are at-home OTC antigen COVID-19 diagnostic test kits covered?
Effective Jan. 15, 2022 through May 11, 2023, Medica members enrolled in individual plans and commercial fully and self-funded plans, and who have their pharmacy benefits through their Medica plan, have coverage for over-the-counter (OTC) FDA-authorized COVID-19 antigen tests without a prescription from a qualified health professional.
- Coverage includes up to eight FDA-approved OTC COVID-19 antigen home tests for each member per month covered under a subscriber's plan.
- Tests can be obtained through a network pharmacy or mail order at no cost using your Medica ID card.
* Tests should be brought to the pharmacy counter to be submitted through the claims process. - If you purchase the test through a retailer (e.g., at the front register), you will be charged the full cost of the test and will need to submit a claim form to be reimbursed. Reimbursement will be $12 per OTC test.
- Tests obtained at an out-of-network pharmacy or retailer are eligible for reimbursement at $12 per OTC test. Members will be required to submit a claim form to process reimbursement.
- OTC tests purchased prior to Jan. 15, 2022 are not eligible for reimbursement.
- Tests purchased to fulfill employer-directed testing requirements are not eligible for reimbursement.
*If you paid out-of-pocket for your OTC antigen tests, you can complete and submit a Pharmacy Claim Submission form
(Note: you don't need to enter the NCPD/NPI or have the form signed by the pharmacy).
Completed forms and receipt(s) can be submitted at Medica.com/SignIn, or mailed to the following address for reimbursement:
Express Scripts
ATTN: Commercial Claims
P.O. Box. 14711
Lexington, KY 40512-4711
Or you can fax your claim form and receipt(s) to 1-608-741-5475.
A listing of FDA-approved Emergency Use Authorization (EUA) COVID-19 antigen tests can be found on the FDA's website.
What is the difference between PCR and antigen COVID-19 diagnostic tests?
A PCR (or Polymerase Chain Reaction) test is used to detect genetic material from a specific organism, such as a virus. PCR tests detect viral RNA. PCR tests are sent to a lab for the assessment of the test. Results generally take a couple of days.
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 antibody testing for COVID-19 covered?
Yes. We'll waive your copays, coinsurance, and deductibles for Food and Drug Administration (FDA)-approved antibody tests after a suspected (not confirmed) COVID-19 diagnosis. An in-network provider must order the tests, and they must be medically needed. Testing isn't covered as part of a return-to-work requirement, public surveillance program, or travel requirement.
Coverage for the antibody test applies both in-network and out-of-network. It includes office visits and other charges related to the antibody test when performed at in-network locations.
This coverage will extend through the public health emergency which is set to expire on May 11, 2023.
Do I need to see a doctor in my network to get tested for COVID-19?
It depends on the state where you purchased your policy.
- Iowa, Kansas, Missouri and Nebraska Policies:
You must see a network provider for coverage of COVID-19-related costs. - Oklahoma Policies:
You must see a network provider for coverage of COVID-19-related costs. If you visit an out-of-network provider, services will apply to out-of-network benefits. - Minnesota, North Dakota and Wisconsin Policies:
You can see any provider for coverage of COVID-19-related costs.
If I suspect I have COVID-19, how do I know if I'm eligible to get tested?
Call your primary care provider if you have a cough, fever, or shortness of breath to find out if you meet testing criteria.
If I suspect I have COVID-19, how do I find a clinic that can test me?
If your primary care provider recommends that you be tested, you may be sent directly to a testing center.
Is monoclonal antibody treatment covered?
Most COVID-19 monoclonal antibody treatments have been discontinued for use. FDA discontinued the Emergency Use Authorization (EUA) for nearly all of the drugs it previously approved. During the time when the EUA was in effect, Medica did provide coverage with no member cost when the treatment was medically necessary and ordered and received by an in-network medical professional.
How are COVID-19 oral treatment drugs covered?
COVID-19 oral treatment drugs will be included in the preferred brand tier on Medica's Drug List. During the national public health emergency, which is set to expire May 11, 2023, members will not be responsible for the ingredient cost of the COVID-19 oral treatment drug. Members will pay approximately $6 or their preferred brand copayment, whichever is less. After the national public health emergency ends, members will be responsible for their preferred brand copayment.
Do I need to see a doctor in my network to get treatment for COVID-19?
It depends on the state where you purchased your policy.
- Iowa, Kansas, Missouri and Nebraska Policies:
You must see a network provider for coverage of COVID-19-related costs. - Oklahoma Policies:
You must see a network provider for coverage of COVID-19-related costs. If you visit an out-of-network provider, services will apply to out-of-network benefits. - Minnesota, North Dakota and Wisconsin Policies:
You can see any provider for coverage of COVID-19-related costs.
Are virtual care services available?
Yes, virtual or telehealth visits are covered as part of your plan. Sign in to find a provider in your network.
We've expanded telehealth visit availability to include visits that:
- Are from your home
- Use technologies such as FaceTime or Skype
- Use audio only when video isn't available
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
Get answers to frequently asked questions about COVID-19 vaccine coverage and availability in this PDF.
I don't have health insurance coverage. Can I sign up now?
It depends on your state of residence.
Minnesota Residents:
The MNsure Health Insurance Marketplace announced a limited Special Enrollment Period that will allow uninsured individuals to get covered. You must enroll in coverage by April 1. Coverage will start on April 1. Visit MNsure for more information.
Go to mnsure.org
Iowa, Kansas, Missouri, Nebraska, North Dakota, Oklahoma, and Wisconsin Residents
At this time, you can only enroll in coverage if you experience a qualified life event. Examples include losing your employer-sponsored coverage, having a baby, or moving outside your plan's service area.