Understanding COVID-19

Information for Our Members 

Following the expiration of the COVID-19 Public Health Emergency (PHE) on May 11, 2023, MVP Health Care® (MVP) will make the following changes. Beginning May 12, 2023, important updates include: 

  

 

Understanding COVID-19

  • COVID-19 Treatment

    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).

  • COVID-19 Diagnostic Lab Testing

    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:

     

    • MVP Medicaid, Child Health Plus, and HARP members will continue to receive fully covered diagnostic tests until September 30, 2024.

    • In-network pharmacies will have $0 cost-share for Medicare members with Part B benefits. 

    • Standard plan cost-shares will apply for tests administered or completed by out-of-network providers. 

  • Over-the-Counter COVID-19 Tests

    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:

    • MVP Medicaid, HARP, and Child Health Plus members may continue receiving a limited number of FDA-authorized COVID-19 test kits without cost-share through September 30, 2024. To qualify for coverage, “at-home” test kits must be authorized by the FDA for use in both symptomatic and asymptomatic patients and allow for self-collection without medical observation.

  • Ambulance Transportation

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

    Exceptions:

     

    • Medicaid, Child Health Plus, or HARP members do not have a cost-share for ambulance transportation under Fee-for-Service Medicaid.

  • Employer and Broker Resources

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

  • Does My Health Plan Cover the COVID-19 Vaccine?
    Yes, the COVID-19 vaccine is covered under all MVP health plans and is free for all MVP members. There is no co-pay and $0 cost-share when you get the vaccine from a provider who participates with MVP. 

    We strongly encourage you to get the vaccine. 

    For more information on the COVID-19 vaccine, including availability and other frequently asked questions, visit the New York State Department of Health website or the Vermont Department of Health website. 
  • Is the COVID-19 Vaccine Safe? 
    Yes, the COVID-19 vaccine is safe. Vaccines are only given to the public once they are determined to be safe and are approved by the Food & Drug Administration (FDA). Scientific data—including effectiveness and safety across ethnicities—from the COVID-19 clinical trials has been reviewed by the FDA and a separate independent advisory body, the Advisory Committee on Immunization Practices (ACIP). Learn more about the COVID-19 vaccine.
  • What Should I Know About the Vaccine for Kids? 

    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. 

  • How Can I Get the Vaccine? 
    Everyone six months and older is eligible for the COVID-19 vaccine, which can be administered at pharmacies, health care provider offices, and state-run vaccine sites. Appointments may be required, and some locations may offer walk-in vaccinations (no appointment necessary). Find a COVID-19 vaccine near you.
  • Are Adverse Reactions to the Vaccine Covered? 

    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: 

    Cost share is dependent upon place of service. 

  • If I’ve Already Had COVID-19 and Recovered, Should I Still Get the Vaccine? 

    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. 

  • Information on Topics Related to COVID-19.

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

MVP will continue to monitor state and federal updates. Additional changes to MVP Protocols and other policies may be implemented. MVP remains committed as always to delivering quality care for your health and well-being and will share further updates as soon as they become available.

 

Questions?

To find detailed benefit and cost-share information for your plan, sign into Gia, then choose My Plan, then My Benefits.

If we can help in any way, please contact us, or call the MVP Member Services/Customer Care Center at the phone number on the back of your MVP Member ID card.

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