COVID-19 Public Health Emergency (PHE) Expired

The temporary provisions to waive cost sharing for COVID-19 testing and related visits ended on May 11, 2023.

Learn how this affects your current coverage.

How We are Helping with the Coronavirus (COVID-19)

Optima Health is closely monitoring the spread of the coronavirus (COVID-19). We have enacted our emergency management protocols and our dedicated team continues to monitor and follow COVID-19 closely in Virginia.

  • Members

    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.

      • COVID-19 OTC at-home test kits are still covered as follows:
        • With prescription: covered under your plan 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

      If you purchased your own Individual & Family plan or coverage through your employer, please refer to the Frequently Asked Questions or your plan benefit documents for cost shares related to the above services.

      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.

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    • Providers

    • Employers and Brokers

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    Health Plans for Individuals

    If you or someone you know has recently gone through a life change due to the coronavirus, and need a new health plan, there are options available to help you.

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