COVID-19 Resources

Stay safe, stay informed

Check out this fact sheet to get details about coverage for COVID-19 services and more.

Health plan coverage for COVID-19 testing, treatment, and vaccines

The information included here applies to coverage for Capital Blue Cross Medicare members. To check the details for your coverage, refer to your Evidence of Coverage information or call the number on the back of your ID card (TTY:711).

Vaccines and boosters

Safety measures like COVID-19 vaccines are making a difference. People who get a vaccine are at lower risk of serious illness and hospitalization.

Members have coverage for COVID-19 vaccines as a preventive service with no cost share when you get a vaccine from an in-network provider. We recommend you use MyCare Finder to find an in-network provider that accepts your plan’s benefits. If you receive a vaccine from an out-of-network provider, you may have to pay out-of-pocket costs.

  • Get more details about vaccines and boosters by visiting the Centers for Disease Control and Prevention’s COVID-19 vaccine webpage.
  • Contact your provider if you have specific questions about vaccines.
  • You can also find general information in our COVID-19 vaccines FAQ.

Diagnostic testing

Medically necessary COVID-19 diagnostic tests are covered; however, cost share may apply for services based on your plan’s benefits. We recommend you use MyCare Finder to find an in-network provider that accepts your plan’s benefits.

Testing for employment purposes or general tracking is not covered.

Over-the-counter (OTC) tests

The cost of OTC tests for COVID-19 are not covered through medical or pharmacy benefits. However, you may be eligible to purchase tests using your over-the-counter benefit, if applicable for your plan.

Provider visits resulting in a COVID-19 test.

Cost share for office, urgent care, or emergency room visits resulting in a COVID-19 test will be covered; however, cost share may apply based on your plan’s benefits. We recommend you use MyCare Finder to find an in-network provider that accepts your plan’s benefits.

Inpatient treatment for COVID-19

Inpatient treatment for COVID-19 is covered; however, any member cost share (such as deductibles, copays, and coinsurance) will apply based on your plan’s benefits.

Oral antivirals and monoclonal antibody treatments for COVID-19

We are continuing to cover monoclonal antibody treatments that are authorized by the U.S. Food and Drug Administration (FDA) for emergency use. Monoclonal antibody products used for COVID-19 treatment will be covered at no member cost year through the end of the calendar year in which the FDA’s emergency use authorization for the product ends.

Paxlovid, an oral antiviral for COVID-19, is covered at no member cost.

Out-of-network services

All out-of-network claims will be processed according to your Medicare Advantage plan benefits.

If you choose to see an out-of-network provider and your plan has out-of-network benefits, you will be required to pay any member cost-share for out-of-network services required through your plan. If you choose to see an out-of-network provider and your plan does not have out-of-network benefits, you will be required to pay the full amount owed (except for urgent or emergency care services).

Please check your Evidence of Coverage to find out if your Medicare Advantage plan has out-of-network benefits.

Claims and appeals

  • In many cases, members had extra time to file a claim or an appeal during the government’s COVID-19 public health emergency (PHE). The PHE ended on May 11, 2023. If you are a member who gets your insurance through your employer or through an individual/family policy, a temporary rule gave you extra time to file claims and appeals while the PHE remained in effect. For example, most members had up to 180 days to file an appeal from the date of an adverse benefit decision, such as a claim denial. The temporary rule currently gives you up to one additional year to file an appeal, so you have the normal 180 days plus one additional year. The temporary rule expired on July 10, 2023.
  • If your insurance is from a state or local government plan, you may not be eligible for extra time since the temporary rule did not apply to those plans.
  • Please keep in mind that the temporary rule ended 60 days after the PHE ended, and normal claims and appeals deadlines will go back into effect at that time. A claim or appeal submitted on or after July 11, 2023 must be within the number of days allowed for an appeal as specified in your Evidence of Coverage and on the back of any Explanation of Benefits (EOB) statements you receive.

Telehealth and teledentistry

  • Telehealth

    Members may use telehealth to connect remotely by video with in-network providers for certain services covered under their health plan. Members may also connect with providers by phone.

    Check your Evidence of Coverage for details about your telehealth coverage.

  • VirtualCare

    Our VirtualCare benefit offers another effective way for members to get care, including behavioral health services and nutrition counseling. It can be a convenient option if you get sick while traveling in the U.S., when you don’t feel well enough to leave the house or the weather is bad, or if your doctor’s office is closed. VirtualCare doctors can diagnose common illnesses and send prescriptions straight to your pharmacy.

    VirtualCare is covered by most Capital Blue Cross health plans. To check on your coverage, refer to your Evidence of Coverage or call the Member Services number on the back of your ID card (TTY: 711) for assistance.

  • Teledentistry

    For members with Capital Blue Cross Dental coverage, in-network teledentistry consultations are covered by your plan. If you'd prefer to have a teledentistry visit, contact your dentist's office to see if teledentistry visits are available.

Need health coverage?

We can help you find coverage. Call 800.990.4201 to speak to one of our licensed agents about your options.

Additional resources

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Updated January 1, 2025

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