On January 30, 2023, the Administration announced a Statement of Administration Policy declaring their intent to terminate the COVID-19 national emergency and public health emergency (PHE) on May 11, 2023. 

Subsequent to the PHE termination, beginning August 1, 2023, we will modify our Ambetter Health benefit coverage on certain COVID-19 related services. This includes changes to cost-sharing requirements for various COVID-19 testing, screening, and vaccination services. Please refer to the following Q&A’s for more information.

Do you have any questions about this PHE termination or the covered benefits impacted by it? Please contact Member Services.

Yes, when medically necessary diagnostic testing is ordered and/or referred by a licensed health care provider, your Ambetter Health plan will cover the cost of COVID-19 tests and the associated physician’s visit. 

Beginning August 1, 2023, your plan’s copayment, coinsurance and/or deductible cost- sharing requirements will apply for medically necessary COVID-19 diagnostic testing and/or medical screening services.

Beginning August 1, 2023, your plan will no longer cover COVID-19 Over-the-Counter and/or Home Testing Kits.

Yes, medically necessary antibody testing is covered when ordered and/or referred by a licensed health care provider.

Beginning August 1, 2023, your plan’s copayment, coinsurance and/or deductible cost- sharing requirements will apply on COVID-19 antibody tests.

Yes, your plan will cover medically necessary COVID-19 treatment related services consistent with benefit provisions of your policy for treatment of an illness. 

Beginning August 1, 2023, your plan’s copayment, coinsurance and/or deductible cost- sharing requirements will apply for medically necessary COVID-19 related treatment(s).

Prior authorization may be required for certain services and/or settings. Please refer to your plan’s policy provisions or contact Member Services for more information.

When services are performed by an In-Network, participating provider, COVID-19 vaccines will be covered at no cost to you. You do not need to obtain a prior authorization for your vaccines when services are performed by an In-Network, participating provider.

Beginning August 1, 2023, general plan requirements will be re-enforced for services that are performed by an Out-of-Network, non-participating provider. Members will incur out-of-pocket costs for COVID-19-related services, including costs associated with Out-of-Network services. Refer to your plan documents for more details on Out-of-Network coverage options and/or contact Member Services for more information.

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

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.

Contact your Primary Care Physician or local In- Network  Pharmacy to confirm your eligibility and to schedule an appointment for your booster. You should present your COVID-19 Vaccination Record Card.

Yes. Please contact Member Services. You may be able to receive transportation by contacting United Way-211 to access local community resources for transportation, which may include the Lyft Vaccine Alliance Program.

Yes, your plan utilizes Teladoc to provide telehealth services. All telehealth consults are now screened for COVID-19 symptoms and risk factors. Teladoc providers will evaluate your symptoms and contact history to assess your COVID-19 risk, and then help guide you through the next steps for care and testing, if needed. We are also encouraging members to use telehealth visits for non-urgent health issues. If you haven’t used Teladoc before, you can visit their website or download the mobile App to get started. You can download the Teladoc app on the App Store or Google Play. 

In addition to Teladoc, you may also be able to set up a telehealth consultation directly with your primary care provider. You can reach out to your primary care provider or their office to see what kind of virtual care options are available to you. 

Beginning August 1, 2023, we will reinstate coverage and/or member cost-share responsibility in accordance with the general terms of your plan’s policy provisions.

Please refer to your plan’s policy provisions or contact Member Services for more information.

Save Money and Get Your Prescriptions Delivered to Your Door!  

Prescription Delivery  

As an Ambetter Health member, you can maximize your pharmacy benefits by filling your prescriptions by mail. Eligible members may save when ordering a 90-day supply*. Delivery is free and can be to your home, workplace or any address you choose.  

Prescription delivery may be right for you if you take medications regularly for conditions like high blood pressure, arthritis or diabetes.  

Two easy ways to get started: 

1. Call your provider and ask them to send a new 90-day prescription to Express Scripts® Pharmacy. 
2. Or request prescription delivery in your online member account.

*Members may save when they fill eligible medications, 90 days at a time, through Express Scripts® Pharmacy. 

You may receive free masks (N95 respirators) at a participating location near you by visiting the Center for Disease Control and Prevention’s Find Free Masks site or calling 1-800-232-0233 (TTY 1-888-720-7489).