COVID-19 vaccine coverage and eligibility

Individual and Family or Employer Group coverage+
In-network: COVID-19 vaccines, including all doses, boosters, and administration will continue to be covered at no cost share to you.

Out-of-network: Standard coverage and cost sharing will apply to vaccines obtained out-of-network (unless otherwise prohibited by state guidance such as in Oregon). Please refer to your Benefit Summary for more details.

Medicare Advantage +

COVID-19 vaccines are covered under Part B at no cost share to you.
This includes appropriate doses, boosters, and administration services as recommended by your physician.

Medicaid +
COVID-19 vaccines are covered at no cost share to you through September 30, 2024, per federal guidance.

For more information on COVID-19 vaccines, visit our COVID-19 Vaccines page.

Will COVID-19 vaccines be affected by the end of the PHE?
The department of Health and Human Services’ stated that they remain committed to maximizing continued access to COVID-19 vaccines.

The FDA has approved two COVID-19 vaccine and has authorized additional COVID-19 vaccines under the FDA Emergency Use Authorization (EUA). Per the U.S. Department of Health & Human Services, the FDA’s EUAs for COVID-19 vaccines will not be affected with the ending of the COVID-19 PHE. Existing EUAs for COVID-19 vaccines will remain in effect under Section 564 of the Federal Food, Drug, and Cosmetic Act. When reviewing an EUA, the FDA carefully considers the potential benefits and risks of a product based on the current data.

For more information on which COVID-19 vaccines are FDA approved or have Emergency Use Authorization (EUA), visit our COVID-19 Vaccines page.

For Providence Health Plan (PHP) Individual and Employer Group health plan members

Beginning January 15, 2022 and ending June 30, 2023, Providence will cover most individual and employer group health plan members’ FDA-authorized Over-the-counter (OTC) at-home COVID-19 diagnostic tests purchased on or after January 15, 2022, without a doctor’s prescription. This benefit for OTC at-home COVID-19 test includes up to 8 tests per member aged 2 and older every 30 days.

When the public health emergency ends, coverage for some items, such as vaccines and testing will change to align with your plan benefits.

The following changes will occur as of July 1, 2023:

• Over-the-counter testing: Will not be covered.

*ASO groups may determine to cover COVID-19 testing differently.

For more information on OTC COVID-19 testing, visit our COVID-19 testing and treatment page.

For Providence Health Assurance (PHA) Medicare Advantage plan members
PHA will cover FDA-authorized OTC at-home COVID-19 diagnostic test purchased on January 15, 2022 through April 14, 2022, without a doctor’s prescription. This benefit for OTC at-home COVID-19 test includes up to 8 tests per member every 30 days.

Effective April 15, 2022, members with Original Medicare Part B coverage including those enrolled in a Medicare Advantage plan can get up to 8 free OTC at-home COVID-19 tests for each calendar month at authorized pharmacies or other participating entities through the end of the federal public health emergency. Members will be able to receive the OTC COVID-19 tests at no cost and will not need to be reimbursed, as Original Medicare will pay the pharmacy or other entity directly. Bring your red, white and blue Medicare card to get your free tests, even if you have a Medicare Advantage or Medicare Part D plan, in the event the pharmacy needs your Medicare information. You can learn more about this program here.

Effective May 11, 2023, Original Medicare Part B will stop covering OTC at-home COVID-19 tests.

For more information on OTC COVID-19 testing, visit our COVID-19 testing and treatment page.

For Providence Health Assurance (PHA) Medicaid Plan Members
PHA will cover FDA-authorized OTC at-home COVID-19 diagnostic test purchased on March 11, 2021 through February 17, 2022, without a doctor’s prescription. This benefit for OTC at-home COVID-19 test includes up to 4 tests per member every 30 days.

PHA will cover FDA-authorized OTC at-home COVID-19 diagnostic test purchased on or after February 18, 2022 through September 30, 2024, per federal guidance, without a doctor’s prescription. This benefit for OTC at-home COVID-19 test includes up to 8 tests per member every 30 days.

For more information on OTC COVID-19 testing, visit our COVID-19 testing and treatment page.

What changes to COVID-19 testing coverage will happen due to the end of the COVID-19 Public Health Emergency?

On and after July 1, 2023:
For commercial fully insured and ASO* plan members, benefits for COVID-19 testing (including lab testing, direct-to-consumer testing, and over-the-counter testing) aligns with member health plan benefits, specifically:

• Lab testing: Covered when medically necessary at the same benefit and cost share as other medically necessary lab tests (may include a member cost share).
• Direct-to-consumer testing (i.e., collection taken at member’s home and sent to a lab for processing and results): Will not be covered.

*ASO groups may determine to cover COVID-19 testing differently.

On and after May 12, 2023:
For Providence Health Assurance (PHA) Medicare Advantage plan members, benefits for COVID-19 testing will be affected as follows:

• Lab testing: laboratory testing related to COVID-19 will align with member health plan benefits. Covered when medically necessary at the same benefit and cost share as other medically necessary lab tests (may include a member cost share).
• Direct-to-consumer testing (i.e., collection taken at member’s home and sent to a lab for processing and results): Will not be covered.
• Testing for employment purposes: Will not be covered.

For Providence Health Assurance (PHA) Medicaid Plan Members

• COVID-19 testing is covered at no cost share to members until September 30, 2024.

For more information on COVID-19 testing, visit our COVID-19 testing and treatment page.

Will COVID-19 medications with Emergency Use Authorizations (EUA) be affected by the end of the COVID-19 Public Health Emergency end?
Per the United States Department of Health and Human Services, the FDA's EUAs for the COVID-19 treatments will not be affected. Existing EUAs for COVID-19 treatments will remain in effect under Section 564 of the Federal Food, Drug, and Cosmetic Act, and the agency may continue to issue new EUAs going forward when criteria for issuance are met.

Will any changes to COVID-19 treatment coverage happen at the end of the COVID-19 PHE?
No changes will occur to COVID-19 treatment coverage when the COVID-19 PHE ends. Currently, COVID-19 treatments are federally funded.
For more information on COVID-19 treatment, visit our COVID-19 testing and treatment page.

Will office visits related to COVID-19 be affected by the end of the COVID-19 Public Health Emergency end?

On and after July 1, 2023: 
For commercial fully insured and ASO plan members, benefits for COVID-19 office will align with member health plan benefits. Please refer to your Benefit Summary for more details.

On and after May 12, 2023: 
For Providence Health Assurance (PHA) Medicare Advantage plan members, benefits for COVID-19 office visits will align with member health plan benefits. Please refer to your Benefit Summary for more details.

For Providence Health Assurance (PHA) Medicaid Plan Members: 
No changes will occur to COVID-19 office visit coverage when the COVID-19 PHE end.