The COVID-19 pandemic is likely to raise questions about what your plan covers. Several frequently asked questions (FAQs) are addressed below, along with information on medication availability, and other useful links to COVID-19 information. For additional questions or concerns, contact the Member Services team at (855) 624-6463, Monday through Friday, 8 a.m. to 6 p.m., or via email email@example.com.
COVID-19 related healthcare coverage
What is Health Options’ coverage for COVID-19-related provider appointments?
Through the duration of the COVID-19 health emergency, we are waiving cost-sharing for provider-recommended COVID-19 testing and associated lab processing fees, the office, ER, or urgent care visit to collect the specimen, COVID-19 telehealth screening services with your provider's office, and COVID-19 treatment among our in-network acute care facilities. All other testings, treatments, and services are subject to applicable cost-share.
Where can I get tested for COVID-19?
The Maine Department of Health and Human Services (DHS) offers testing for residents and visitors through "swab and send" sites. These sights offer specimen collection and testing free of charge to individuals, with or without symptoms, who believe they may have COVID-19 or could have been exposed.
If you think you may have COVID-19 symptoms, visit the Federal CDC Coronavirus Self-Checker.
For testing site information, go to Get-Tested-COVID19.org.
As a reminder, please bring your health insurance ID card with you whenever you seek medical care, including any appointments for COVID-19 testing or vaccine administration.
Where can I get the COVID-19 vaccine?
All Mainers ages 12 and older are eligible for the vaccine. Please visit the Maine.gov webpage for a list of all vaccine locations: https://www.maine.gov/covid19/vaccines.
Can immunocompromised individuals (whose immune system defenses are low due to an underlying chronic health condition or because they are taking certain medications that may decrease immune system function) receive the COVID-19 vaccine?
Immunocompromised individuals can receive the COVID-19 vaccination. The current FDA-authorized COVID-19 vaccines are not live vaccines and therefore can be safely administered to these groups. Individuals who are or may be immunocompromised due to a chronic health condition or certain medications may benefit from having a conversation with their provider to discuss the most appropriate timing for getting the COVID-19 vaccine.
Is the COVID-19 vaccine FDA approved?
Currently, the Pfizer version is the only COVID-19 vaccine to receive FDA approval. The vaccine, previously known as Pfizer BioNTech COVID-19 Vaccine, now goes by the brand name Comirnaty. The vaccine is approved for individuals 16 years of age or older. Individuals 12 through 15 years of age can continue to receive the Pfizer BioNTech COVID-19 vaccine under the Emergency Use Authorization.
Is the COVID-19 vaccine free?
At this time, the COVID-19 vaccine and administration charges continue to be available with no out-of-pocket costs.
Will my vaccination be free even if I don’t receive it from my in-network primary care provider?
Vaccine doses will be available with no out-of-pocket costs, even if you get vaccinated from a facility or provider other than your PCP.
What does it mean to be “fully vaccinated?”
People are considered fully vaccinated:
2 weeks after their second dose in a 2-dose series, such as the Pfizer or Moderna vaccines, or
2 weeks after a single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine
Are there places where masks are still required, even if you are fully vaccinated?
Federal rules still require everyone – regardless of inoculation status – to wear masks on buses, planes, trains, and other forms of public transportation. Businesses will still be allowed to require masks for customers and employees. The federal recommendations also suggest masking in correctional facilities and homeless shelters. Additionally, hospitals and other health care settings will likely continue to require masks for everyone, per the recommendation from the CDC.
What activities can I do once I have been fully vaccinated?
Once fully vaccinated you can:
Resume activities that you did prior to the pandemic.
Resume activities without wearing a mask or physically distancing, except where required by federal, state, and local regulations, including local businesses and workplace guidance.
Gather indoors with unvaccinated people of any age who are not at risk for severe illness.
Travel domestically without pre- or post-travel COVID-19 testing or quarantining. (You still must wear a mask.)
Travel to some international destinations without pre-travel testing or quarantining. You still must wear a mask and should get tested 3-5 days after international travel. Read Maine CDC guidelines here.
You should not:
Attend medium or large gatherings.
If you have a condition or are taking medication that weakens your immune system, talk to your healthcare provider to discuss what activities you can do.
Learn more here.
How do I know if I need to quarantine?
Quarantine keeps people who might have been exposed to COVID-19 away from others to help prevent the spread of disease. Not everyone infected shows or feels symptoms. If you think you may have been exposed to COVID-19 or have traveled out of the state, please check Maine’s quarantine guidelines here.
Where can I get help for COVID-19 related stress and anxiety?
Click here to use the Health Options’ provider lookup tool to find a behavioral health provider near you. Health Options and some providers offer telehealth services. If you are experiencing an emergency, dial 911, go to a local emergency room or call the State of Maine Crisis Hotline at 1-888-568-1112.
Getting non-COVID-19 care during the pandemic
Is remote access to providers available during the pandemic?
Some providers offer telehealth services that enable you to get advice via remote access. Contact your provider’s office to see if this option is available.
Are telehealth visits covered?
A telehealth visit with your in-network provider is treated in the same manner as an in-person appointment. Coverage is based on your plan benefits.
Can I receive infusion therapy at home as a covered service?
Home infusion may be possible. Health Options partners with local companies that provide infusion services in your home. Find out what medications are eligible for home infusion services by calling Member Services at (855) 624-6463, Monday through Friday, 8 a.m. to 6 p.m.
Can I obtain an early refill for my medications?
In many cases, due to the virus outbreak, you can receive an early refill on medications taken regularly. Contact your local pharmacy or take advantage of our home delivery pharmacy here.
Can I obtain an early refill of medications from Accredo?
You can request, and in many cases, obtain what pharmacists call an “emergency refill too soon” order by calling the phone number on your prescription label or calling Accredo at (877) 895-9697.
Can I use Home Delivery for my medication needs?
Yes, you can sign up for Home Delivery by calling (800) 282-2881. You can request, and in many cases, receive an early refill from Home Delivery by calling their pharmacy at (877) 861-0376 and asking for an early refill due to the virus outbreak.
If you have other questions, please contact Member Services at (855) 624-6463 or firstname.lastname@example.org.
Other sources of COVID-19 information
For the latest information about Maine’s response to the COVID-19 pandemic, data, and other resources: https://www.maine.gov/dhhs/mecdc/.
Maine’s COVID-19 vaccination updates can be found here: https://www.maine.gov/covid19/vaccines/vaccination-sites.
If you are feeling stress and anxiety and need COVID-19 coping strategies, we recommend visiting https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html.
For information and updates on the federal response to COVID-19, go to https://www.maine.gov/dhhs/mecdc/.
If you are helping friends or family who do not have internet access, dialing 211 will access the United Way’s services in your area.
The posted content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your provider or another qualified health provider with any questions you may have regarding a medical condition.