COVID-19 member benefits update

Members with individual and family or employer group pharmacy coverage*

The COVID-19 National Emergency and Public Health Emergency declarations will end on May 11, 2023. Except for Medicare Advantage plans, coverage of COVID-19-related services will change, effective for dates of service on or after May 12, 2023. See below for details:

COVID-19 vaccines

• In network: Moda Health will continue to cover COVID-19 vaccines at no cost-sharing.
• Out of network: Standard coverage and cost-sharing applies. See your Member Handbook or visit your Member Dashboard for more details.

COVID-19 tests

• Over-the-counter tests: Moda Health will no longer cover COVID-19 at-home tests.
• Lab tests: COVID-19 lab tests will have the same coverage and cost-sharing as standard lab tests. See your Member Handbook or visit your Member Dashboard for details.

*Please note these changes broadly apply to most fully-insured plans. Self-funded plans may or may not offer this same coverage. To find out if a member is enrolled in a self-funded plan, refer to the bottom of their ID card for "third-party administrator" language. If they are enrolled in a self-funded plan, contact customer service to learn about COVID-19 coverage available to them.

If you are an OEBB or PEBB member

See our OEBB and PEBB websites for coverage details.

If a member has a Medicare Advantage plan

Moda Health will continue to offer the same COVID-19-related benefits listed below through the remainder of 2023

• As a Medicare enrollee, members can get vaccinated for COVID-19 at no cost.
• Cost-sharing is waived for COVID-19 testing needs, including:
  • Telehealth or in-person visits to be evaluated for COVID-19 testing
  • Provider office visits, urgent care center visits, or emergency room visits to be tested for COVID-19
  • COVID-19 lab tests for all testing facilities
  • Serological anti-body tests
  • Other testing received during a COVID-19 testing visit, when administered to determine the need for COVID-19 testing

This is applicable to in-network and out-of-network providers, facilities and laboratories.

If a member has a Medicare Supplement plan

• Members can get vaccinated for COVID-19 at no cost.
• Cost-sharing is waived for COVID-19 testing for laboratory-conducted COVID-19 tests when ordered by a provider.

Additional resources

It is important to continue to obtain information, data and updates from credible healthcare sources on the front lines of studying the virus, such as the CDC and the Oregon Health Authority.