Understanding COVID-19

Standard plan cost-shares will apply for services associated with the treatment of COVID-19 for members with a New York*or Vermont individual or group-provided plans. Cost-share can mean a co-pay, deductible, or co-insurance. 

MVP will continue to cover services associated with the approved treatment of COVID-19 for Medicaid Managed Care and Medicare Advantage members in accordance with New York State Medicaid and CMS guidelines. 

If your employer group offers a self-funded plan, or you are not sure about your benefits, please contact your health benefits administrator or contact MVP.

*Please note: Standard plan cost-shares were applied for NY individual and group-provided plans beginning August 1, 2021.

Pfizer offers cost sharing programs for Paxlovid, a prescription medication used to treat COVID-19. This is available for commercially insured and Medicare members. If you have commercial insurance, see if you qualify here: Co-Pay Programs | PAXLOVID™ (nirmatrelvir tablets; ritonavir tablets). If you have Medicare, see if you qualify here: PAXCESS™ | PAXLOVID™ (nirmatrelvir tablets; ritonavir tablets).

Standard plan cost-shares will apply for COVID-19 diagnostic tests. In addition, a physician’s order is now required for all tests including diagnostic testing done at a pharmacy.

Exceptions:

Over-the-counter COVID-19 tests will no longer be covered. These are also known as “at-home” tests. Members will pay full retail price for at-home tests. 

Exceptions:

Standard plan cost-shares will apply for ambulance transportation for members with a COVID-19 diagnosis or symptoms.

Exceptions:

You can learn more about the changes regarding COVID-19 and the PHE unwind in the employer and broker section of our website.

The most important thing to know is that clinical trial data shows that the COVID-19 vaccine is safe and effective for children ages as young as 6 months. Side effects may occur and could include pain at the injection site, fatigue, and/or headache, which are likely to resolve within one to two days and are similar to the side effects seen with other vaccines children routinely receive.

While children are less likely to have severe disease from COVID-19 than teens and adults, they are not immune to the disease. Some children have become very sick and required hospitalization, including healthy children who did not have underlying conditions—nearly one third of those children hospitalized have needed care in the intensive-care unit (ICU). Experts have concluded that the known benefits of receiving the vaccine outweigh the risks of contracting COVID-19.

See the CDC’s vaccine schedule for children six months through 17 years (PDF).

Learn more about COVID-19 vaccines for children.  

You should also speak with your child’s health care provider to discuss any questions or concerns you may have. 

Yes. Treatment for any adverse reactions is medically necessary and covered by us. You should refer to your schedule of benefits or call the Customer Care Center at the number located on the back of your MVP Member ID card for cost share information. View guides to your Member ID card: 

• Child Health Plus (PDF)
• New York fully insured members
• Other members

Cost share is dependent upon place of service. 

Yes. Even if you had COVID-19 and recovered, re-infection is possible. Studies have shown that immunity from the vaccine is more reliable than immunity from a natural infection of COVID-19.

If you were treated for COVID-19 with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine. Talk to your doctor if you are unsure what treatments you received or if you have more questions about getting a COVID-19 vaccine. 

For up-to-date information on COVID-19, including vaccines and safety guidance, visit: 

• The Centers for Disease Control (CDC) and Prevention website
• The New York State Department of Health website
• The Vermont Department of Health website