Temporary Provisions to Waive Cost Sharing for COVID-19 Testing and Related Visits Ending 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.

Recently, 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.” The Administration is planning for the federal Public Health Emergency (PHE) for COVID-19 to expire at the end of the day on May 11, 2023.

What Does This Mean for Me?

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 tests (8 per member per month) are ending May 11, 2023. Please note the following about your cost sharing for these services starting May 11, 2023:

COVID-19 over the counter (OTC) at-home test kits will continue to be covered as follows:

  • with prescription: covered under your plan pharmacy benefits at the tier 1 cost share and will be limited to four tests per month unless medically necessary
  • without a prescription: not covered

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

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

COVID-19 vaccines:

  • in-network: covered as a preventive health service and will continue to be $0 for all plan types
  • out-of-network: not covered under HMO plans

For more information and ongoing updates, visit optimahealth.com/covid-19. Please contact member services at the number listed on the back of your member ID card if you have additional questions.