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Medicaid Members COVID-19 Information

What you need to know about COVID-19

Coronavirus Disease 2019 (COVID-19) is a new disease that causes respiratory illness in people and can spread from person to person. People of all ages can be infected. Older adults and people with pre-existing medical conditions like asthma, diabetes and heart disease may be more likely to become severely ill if infected. Many details about this disease are still unknown, such as treatment options, how the virus works, and the total impact of the illness.

What is the coronavirus?

COVID-19 is a respiratory disease that is caused by a new virus called a coronavirus, which has become a public health emergency. The number of cases continue to increase nationally and globally.

What are the symptoms?

The symptoms of coronavirus include mild to severe respiratory symptoms. Symptoms include fever, cough, and shortness of breath, and lower respiratory illness. COVID-19 can be contagious before a person begins showing symptoms.

What else causes similar symptoms?

Influenza (the flu), a contagious respiratory illness caused by the influenza viruses (Type A and Type B), has high activity in the United States at this time. Everyone 6 months of age and older should get a flu vaccine.

I may have symptoms. What do I do?

If you have been exposed or begin showing symptoms of the virus or flu, contact your healthcare provider or health department immediately.

Protect yourself and your community.

We all have a role to play in protecting our communities and families from the spread of coronavirus. It is similar to other communicable viruses. You can also follow these tips to prevent infection:

  • Wash your hands thoroughly and frequently. Use soap and water for at least 20 seconds.
  • Use an alcohol-based hand sanitizing rub (must contain at least 60 percent alcohol).
  • Cover your mouth when you cough or sneeze by coughing/sneezing into your elbow.
  • Promptly dispose of tissues in a wastebasket after use.
  • Clean public surfaces thoroughly.
  • Stay home when you are sick.
  • Avoid shaking hands.
  • Remember social distancing. Stay six feet away from others, especially those who are sick.
  • Get a flu vaccine.

Does my plan cover COVID-19 testing/screening/treatment services?

Yes. When medically necessary diagnostic testing, medical screening services and/or treatment is ordered and/or referred by a licensed health care provider, we will cover the cost of medically necessary COVID-19 tests, screenings, associated physician’s visit(s) and/or treatment. If applicable, your plan’s co-payment, coinsurance and/or deductible cost-sharing will be waived for medically necessary COVID-19 diagnostic testing, medical screening services and/or treatment.

Is prior authorization required for COVID-19 testing, screening services and/or treatment under my plan coverage?

No. We will not require prior authorization, prior certification, prior notification and/or step therapy protocols for medically necessary COVID-19 diagnostic testing, medical screening services, and/or treatment when medically necessary services are ordered and/or referred by a licensed health care provider.

Where may I receive COVID-19 testing/screening/treatment services under my plan coverage?

Medically necessary COVID-19 diagnostic testing, medical screening services and/or treatment and the associated physician’s visit will be covered when ordered, referred and/or performed in the following In-Network locations:

  • Physician’s/Practitioner’s Office
  • Independent Laboratory/Diagnostic Facility   
  • Urgent Care Facility
  • Emergency Department Facility

Our Governor is establishing limited certified drive through testing sites. Be aware of scammers who are selling fake tests.

Are you unsure if you have been exposed to or at-risk of being infected with COVID-19? Schedule a virtual care visit with a provider. It is a good option for non-urgent care to limit potential exposure in a physician’s office or other healthcare facility.

Will I be responsible for any out-of-pocket costs for COVID-19 testing/screening/treatment services?

No. We will cover medically necessary COVID-19 diagnostic testing, medical screening services and/or treatment at no charge to you, when such services are ordered and/or referred by a licensed health care provider. If applicable, your plan’s copayment, coinsurance and/or deductible cost-sharing will be waived for medically necessary COVID-19 diagnostic testing, medical screening services and/or treatment, along with the associated physician’s visit.

If I need treatment for coronavirus, is that covered by my plan?

Any medically necessary treatment related to COVID-19 would be considered a covered benefit. We are committed to ensuring access to COVID-19 treatment services in accordance with federal and state law.

Will I be able to refill my prescriptions before the refill date?

Yes, members will be able to refill prescriptions prior to the refill date.

What is the COVID-19 vaccine?

There is now a vaccination available that will give you the best chance of protecting yourself and your loved ones from getting COVID-19 in the future. Some COVID-19 vaccines will have two doses a few weeks in between each shot. You will get a COVID-19 Vaccination Reminder Card that will help you keep track of which vaccine you receive and when to get a second dose, if needed. If you receive a vaccine that requires two doses, it is important to get both doses.

Where can I get the COVID-19 vaccine?

The vaccine is being administered to different populations in a tiered approach. When you are able to get the vaccine, call your doctor with any questions and ask when you can make an appointment with them or at your local pharmacy. Or, find out where to get your vaccine at cdc.gov/coronavirus/2019-ncov/vaccines or vaccinefinder.org.

Am I required to get my COVID-19 vaccine?

While it is not a requirement, getting your COVID-19 vaccine will give you the best chance of protecting yourself and your loved ones from getting COVID-19 in the future.

I already had COVID-19. Should I still get the vaccine?

Even if you have already had COVID-19, you should still get the vaccine.  It may be possible to be infected more than once so getting the vaccine is a safe choice.

Can my child get the vaccine?

Currently, the Pfizer-BioNTech vaccine is recommended for people ages 5 and older. The Moderna and Johnson & Johnson vaccines are recommended for those ages 18 and older.

Am I eligible for a booster?

The CDC recommends a booster shot of COVID-19 vaccines in the following populations:

  • For individuals who received a Pfizer-BioNTech or Moderna COVID-19 vaccine:
    • You should get a booster if you are:
    • You may get a booster if you are:
      • Ages 18 years and older
    • When to get a booster:
      • At least 6 months after completing your primary COVID-19 vaccination series
  • For individuals who received Johnson & Johnson’s Janssen COVID-19 vaccine:
    • You should get a booster if you are:
      • 18 years or older
    • When to get a booster:
      • At least 2 months after your shot.

Eligible individuals may choose which vaccine they receive as a booster dose. Some people may have a preference for the vaccine type that they originally received, and others may prefer to get a different booster. CDC’s recommendations now allow for this type of mix and match dosing for booster shots.

I’m pregnant. Should I get the vaccine?

The CDC currently recommends the COVID-19 vaccine for pregnant women. If you have questions about getting the vaccine, it is recommended to discuss with your doctor to make an informed decision.

When I get the vaccine, can I stop wearing a mask or social distancing?

Fully vaccinated is considered two weeks past final dose, meaning the second dose of the Moderna or Pfizer mRNA vaccine, or, two weeks past the single dose Johnson & Johnson vaccine.

To maximize protection from the Delta variant and prevent possibly spreading it to others, wear a mask indoors in public if you are in an area of substantial of high transmission.

Wearing a mask is most important if you have a weakened immune system or if, because of your age or an underlying medical condition, you are at increased risk for severe disease, or if someone in your household has a weakened immune system, is at increased risk for severe disease, or is unvaccinated. If this applies to you or your household, you might choose to wear a mask regardless of the level of transmission in your area.

Fully vaccinated people who have come into close contact with someone with suspected or confirmed COVID-19 to be tested 3-5 days after exposure, and to wear a mask in public indoor settings for 14 days or until they receive a negative test result.

What do we know about the Delta variant?

The Delta variant is highly contagious, nearly twice as contagious as previous variants.

Some data suggest the Delta variant might cause more severe illness than previous strains in unvaccinated persons.

Unvaccinated people remain at the greatest risk for severe illness, hospitalization, and death.

Fully vaccinated people with Delta variant breakthrough infections can spread the virus to others. However, vaccinated people appear to be infectious for a shorter period of time.

Vaccines are highly effective, including against the Delta variant.

What do we know about breakthrough cases for people who are fully vaccinated?

A small percentage of people who are fully vaccinated will still get COVID-19 if they are exposed to the virus that causes it. These are called “vaccine breakthrough cases.” This means that while people who have been vaccinated are much less likely to get sick, it will still happen in some cases. It’s also possible that some fully vaccinated people might have infections, but not have symptoms (asymptomatic infections). Experts continue to study how common these cases are.

If you get COVID-19 after vaccination, your symptoms might be less severe.

Fully vaccinated people are much less likely to be hospitalized or die than people with similar risk factors who are not vaccinated.

Is the vaccine safe?

The safety of the COVID-19 vaccine is a top priority! The Food and Drug Administration (FDA) carefully reviews all safety data from clinical trials and authorizes emergency vaccine use only when the expected benefits outweigh potential risks. COVID-19 vaccines were tested in large clinical trials to make sure they meet safety standards.

Will there be any side effects when I get the vaccine?

You may run a fever after you get the vaccine. This is normal as your body builds immunity and fights off future COVID-19 exposures. You may feel sick after getting vaccinated. You could develop a fever, headache or body aches. This is your body reacting to the vaccine, which is a normal response. It is important to know that it is impossible to get COVID-19 from the vaccine. The vaccines currently in use and others being developed do not contain a live virus.

Do I have to pay for my vaccine? Or get prior authorization?

No. The COVID-19 vaccine will be at no cost to you. You do not need to get a prior authorization for your vaccine.

I lost my COVID-19 Vaccination Record Card. What should I do now?

Please call the administering facility/provider you received your first dose from to ask about your vaccine information and verify your second appointment/location.

I am due for my second dose. I got my first dose from another provider who is not my PCP but I don’t have their contact information. What do I do now?

The provider should have scheduled a second appointment with you at the same facility when you received the first dose. However, you can receive your second dose from another provider/facility and you should present your COVID-19 Vaccination Record Card.

Are there strategies for coping with the COVID-19 outbreak?

Worry and anxiety can rise about the spread of COVID-19. Concern for friends and family who live in places where COVID-19 is spreading or the progression of the disease is natural.

  • Take care of your body. Take deep breaths, stretch or meditate.
  • Connect with others. Share your concerns and how you are feeling with a friend or family member. Maintain healthy relationships and a sense of hope and positive thinking.
  • Share the facts about COVID-19 and the actual risk to others. People who have returned from areas of ongoing spread more than 14 days ago and do not have symptoms of COVID-19 do not put others at risk.
  • For more information, see the CDC’s suggestions for mental health and coping during COVID-19

How can I enroll in Medicaid?

If you have recently lost your job you may instantly qualify for Medicaid. To apply, learn more from the Commonwealth of Kentucky website.

For more information, including travel advisories, please visit cdc.gov.

Federal resource to have 4 free COVID-19 Test Kits mailed to your home: 

https://special.usps.com/testkits