Sentara Health Plans 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.
In February 2023, 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
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 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
Some self-funded employers have opted to continue to cover COVID-19 over-the-counter (OTC) at-home test kits under pharmacy Tier 1. This limits members to four tests per month. Please check with your employer to see if your OTC test kits are still covered.
Please refer to your plan benefit documents for cost shares related to the above services.
Medicaid Coverage
- COVID-19 over the counter (OTC) at-home test kits will continue to be covered through September 30, 2024*
- 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
*Maximum quantity limitation of two OTC test kits per day or eight kits per 30 days
Medicare Coverage
- 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 Sentara Health Plans 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.