(Updated April 5, 2021)

Moda Health has received questions and concerns about the novel coronavirus (respiratory illness), COVID-19 and would like to keep you informed with the most-up-to-date information as it relates to your health and benefits.

To keep everyone safe, providers may:

• Keep following social distancing rules
• Ask patients to wear masks
• Check all patients' temperatures

If you need care that was delayed because of COVID-19, call your provider to schedule an appointment. Your provider may also call you to schedule treatment.

If you already have a provider and need to get care from home, call them to learn about their telehealth options.

If you need to find a provider, you can search for one using Find Care in Member Dashboard. If you have questions or need help finding a provider, call us at the Medical Customer Service number on your identification card.

COVID-19 vaccine availability

The COVID-19 vaccine is now available, and cost-sharing (i.e., copayments, coinsurance and deductibles) is waived.

Please keep in mind that the vaccine supply is limited. The state will determine how vaccine supplies will be prioritized among the population. To view current vaccine eligibility, visit covidvaccine.oregon.gov.

ACA Tax Credits for Individual Plans

The American Rescue Plan Act of 2021 has expanded access to the ACA's tax credits. Effective April 1, 2021, existing enrollees can re-apply via Healthcare.gov to find out if they qualify for tax credit changes.

New applicants to Healthcare.gov who enroll on and after April 1, 2021 will be able to find out if they qualify for additional tax credits upon initial enrollment.

Individuals who enroll during the COVID-19 Special Enrollment Period (February 15. 2021 - Aug. 15, 2021) do not need a special enrollment life event to apply.

All changes are effective the first of the month after your application is received and approved.

Your benefits

If you have an HSA-eligible high deductible health plan (HDHP)

Under current law, HDHPs are effectively prohibited from covering any medical services not deemed preventive care prior to an enrollee satisfying their deductible, as the taxpayer would be subject to federal income tax penalties.

However, the IRS has posted a notice that allows pre-deductible coverage of both testing and treatment of COVID-19, as determined by the health plan. Because the COVID-19 vaccine is considered preventive care, cost-sharing – including the deductible – is waived.

Additional benefits for Oregon medical members on Individual and Family plans or Employer Group* plans

Cost-sharing is waived for COVID-19 vaccines.

Cost-sharing is waived for COVID-19 testing needs, including:

• A telehealth or in-person visit to be evaluated for COVID-19 testing
• Provider office visit, urgent care center visit, or emergency room visit 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.

For members covered on an Individual or Family plan or fully-insured Employer Group* only, cost-sharing is also waived for the in-network medical treatment of COVID-19, both inpatient and outpatient, and FDA-approved medications administered inpatient for the treatment of COVID-19, for services received April 1, 2020 – December 31, 2021, or the end of the Federal Emergency Order. Terms of coverage otherwise apply, including eligibility and medical necessity.

*Please note these additional benefits broadly apply to most fully insured plans. Self-funded plans, Multnomah County, OEBB plans and PEBB plans may or may not offer this same coverage. To find out if you are enrolled in a self-funded plan, refer to the bottom of your ID card for "third-party administrator" language. If you are enrolled in a self-funded plan, OEBB plan or PEBB plan, contact your employer to learn about COVID-19 coverage available to you.

If you have a Medicare Supplement Plan

Cost-sharing is waived for the COVID-19 vaccine.

Cost-sharing is waived for COVID-19 testing needs, including:

• A telehealth or in-person visit to be evaluated for COVID-19 testing
• Provider office visit, urgent care center visit, or emergency room visit 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

If you have a Medicare Advantage plan

As a Medicare enrollee, you can get vaccinated for COVID-19 at no cost. When the vaccine is available to you, be sure to bring your Medicare card with you as the vaccine is covered by Medicare and not your Moda Health plan through 2021.

Cost-sharing is waived for COVID-19 testing needs, including:

• A telehealth or in-person visit to be evaluated for COVID-19 testing
• Provider office visit, urgent care center visit, or emergency room visit 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.

How to protect yourself

• Continue practicing the 3 Ws:
  • Wear a mask
  • Watch your distance
  • Wash your hands
• Practice correct and consistent mask use
• Know the facts and learn about the benefits of the vaccine
• Become familiar with what to expect after getting a COVID-19 vaccine

You can view more helpful tips for slowing the spread and not getting sick, as well as information about the vaccine from the CDC's Covid-19 website.

If you think you are infected

If you are experiencing symptoms of novel coronavirus, such as fever, dry cough or shortness of breath, or believe you have been exposed to COVID-19, we recommend calling your doctor immediately.

In addition to the benefits outlined above, all current Moda Health benefits apply. They may cover additional care options, such as virtual visits, CirrusMD (available on Member Dashboard) and calls to our Registered Nurse Advice Line (866-321-7580) if you can't get in to see your PCP.

Additional resources

If you still have questions about COVID-19 and how it could affect you, the CDC has official responses to frequently asked questions on its website.

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