About COVID-19 Costs
Your BCBSMT health plan covers a lot of the costs of COVID-19 testing, the vaccine, boosters and treatment.
For most plans*:
- Vaccines are covered at no cost.
- If you have employer coverage, or an individual or family plan, your plan will cover FDA-authorized over-the-counter diagnostic tests purchased beginning Jan. 15, up to 8 tests every 30 days per person. If you aren’t sure if a test kit is FDA-authorized, ask your pharmacist for help. If you don’t have pharmacy benefits with BCBSMT/Prime, please contact your health plan administrator for more information.
- Lab tests to diagnose COVID-19 are covered at no cost. (However, tests for things like return to work or school, travel and recreational event requirements may not be covered.)
- Testing-related visits are covered at no cost to you if you see a primary care provider in your health plan’s network, either in person or using telehealth.
- Treatment for COVID-19 is covered by your health plan, meaning copays, deductibles and cost-sharing will be applied as outlined in your benefits. If you are treated by a provider not in your health plan’s network, or for which you were not referred by your HMO Primary Care Physician, you may be responsible for all of your treatment costs except in the case of an emergency.
- The new FDA-authorized oral anti-viral prescription medicines to treat mild to moderate COVID-19 may be covered under your pharmacy benefit. These medicines are Paxlovid and Lagevrio (molnupiravir).** At this time, you won’t pay copays, coinsurance or deductibles. There is a limit of one course of treatment every 30 days per person.
- The federal government has launched a Test to Treat program to help individuals quickly access COVID-19 testing and treatment if they have a positive test result, including a list of nationwide pharmacy locations where prescriptions for these anti-viral medicines can be filled. Other available medications may be covered under your medical benefit. Talk to your doctor about your care options.
If you are unsure what your plan covers, contact your benefits administrator or call BCBSMT Customer Service at the number listed on your member ID card.
Remember to use your BCBSMT member ID card for your doctor’s visit and testing to help with the reimbursement process.
COVID-19 benefit coverage for testing and testing-related visits is available through the end of the public health emergency.