COVID-19 Public Health Emergency Expired May 11, 2023

Optima Health has continuously monitored the spread of COVID-19 to keep you informed of the latest developments and how these changes could affect your health plan.

Earlier this year, the Department of Health and Human Services (HHS) announced that “although COVID-19 remains a public health priority, we are in a much better place in our response than we were three years ago, and we can transition away from the emergency phase.” As a result, the federal Public Health Emergency (PHE) for COVID-19 expired at the end of the day on May 11, 2023.

Commercial Coverage After May 11, 2023

The temporary provisions to waive cost sharing for COVID-19 vaccines, testing, and related services ordered by a physician or other provider, and over-the-counter (OTC) tests (eight per member per month) ended on May 11, 2023. Please note the following about your cost sharing for these services:

COVID-19 OTC at-home test kits are still covered as follows:

  • With prescription: covered under your plan's pharmacy benefits at the tier 1 cost share and are limited to four tests per month unless medically necessary
  • Without a prescription: not covered

COVID-19 tests or related services during a physician visit:

  • Have the applicable cost share depending on where you visit your physician

COVID-19 vaccines:

  • In-network: covered as a preventive health service and are still $0 for all plan types
  • Out-of-network: HMO will not be covered, PPO and POS will be covered at the applicable cost share

Medicaid Coverage After May 11, 2023

  • COVID-19 over the counter (OTC) at-home test kits will continue to be covered
  • COVID-19 tests or related services during a physician visit
  • COVID-19 vaccines 
  • No copayments for Medicaid and FAMIS members
  • Pharmacy: 90-day supply for many drugs
  • Telehealth is permitted for many practice areas and telehealth supplements that provide guidance are attached to the following Medicaid Manuals: ARTS, Mental Health, Psychiatric Services, Physician-Practitioner, Home Health, Early Intervention, and Rehabilitation

Medicare Coverage After May 11, 2023

  • COVID-19 vaccines 
  • COVID-19 at-home tests 
  • COVID-19 pharmaceutical treatments 
  • COVID-19 PCR and rapid tests ordered or given by a health professional

Medicare members can order COVID-19 test kits through our partner, NationsBenefits®. OTC COVID-19 test kits are available for ordering online or by calling 1-877-438-7521 (TTY: 711), Monday through Friday, 8 a.m. to 8 p.m. Kits will be delivered within 7-10 days. Members should have their Optima Health member ID number and plan ID handy when ordering. Please contact member services at the number listed on the back of your member ID card if you have additional questions.