COVID-19 benefit updates

We have received many questions from providers. Our intent is to communicate frequently about changes as they happen and quickly update as additional information emerges. Please check this page regularly for new information. In the event that individual states find themselves facing unique challenges, Humana will work closely with appropriate entities to help support our members there.

2023 Benefits

1. For 2023, during the COVID-19 public health emergency (PHE), Medicare Advantage (MA), commercial and Medicaid benefits included no copays, deductibles or coinsurance for US Food & Drug Administration (FDA)-authorized COVID-19 vaccines and their administration.
   During the PHE, members received the COVID-19 vaccine with no out-of-pocket costs when the vaccine was administered by either an in-network or out-of-network provider. After the PHE, out-of-pocket costs for the COVID-19 vaccine vary depending on the member’s specific plan. Please refer to Humana’s COVID-19 Vaccine policy and COVID-19 Vaccine FAQ, PDF for further information. Medicaid plans will continue to follow state requirements for COVID-19 vaccines.
   
   
2. For 2023, MA benefits include no member cost share for in-network telehealth visits for primary care, urgent care and behavioral health.
   MA members will not be responsible for paying copays, deductibles or coinsurance for the telehealth visits outlined above. For specialty telehealth visits, please verify member plan benefits as any applicable member cost-share would apply. Please refer to Humana’s Telehealth and Other Virtual Services During the COVID-19 PHE policy for further information. Medicaid plans will continue to follow state requirements for telehealth services.
   
   
3. For 2023, during the COVID-19 PHE, member cost share was waived on covered COVID-19-related testing and related services.
   
   Humana MA members:
   During the COVID-19 PHE, there were no out-of-pocket costs for Humana MA and Medicaid members who received a FDA or emergency use authorized COVID-19 test that was performed by a laboratory when the test was ordered by a physician or other licensed healthcare professional. Medicare covered one lab-performed test per member without an order. Testing locations may have required an order or prescription. It was recommended that members contact the testing location for details.
   
   For covered COVID-19 testing provided after the COVID-19 PHE, please verify member plan benefits as any applicable member cost share would apply. In addition, standard ordering requirements apply to lab-performed COVID-19 tests.
   
   Humana Medicaid members:
   Medicaid plans will continue to follow state requirements for COVID-19 testing.
   
   Humana commercial group members:
   Humana commercial group members are eligible for COVID-19 testing for a FDA or emergency use authorized COVID-19 test (including at-home tests) when applicable coverage requirements are met.
   
   Covered COVID-19 testing and related services were available with no out-of-pocket costs during the COVID-19 PHE.
   
   For covered COVID-19 testing provided after the COVID-19 PHE, please verify member plan benefits as any applicable member cost share would apply.
   
   COVID-19 testing must be ordered by a physician or other licensed healthcare professional because the member:
   
   
   • Has COVID-19 symptoms,
   • Has been exposed to someone with suspected or confirmed COVID-19, or
   • Requires pre-admission or pre-procedural testing in an asymptomatic individual.
   
   Humana commercial group members may NOT be eligible for coverage of COVID-19 testing for any indications other than those listed above including, but not limited to, the following:
   
   
   • Employment (e.g., pre-employment, return to work) or school purposes (e.g., return to school);
   • Entertainment purposes (e.g., prior to a concert or sporting event);
   • General population or public health screening;
   • Physicals (executive or routine);
   • Screening in a congregate setting;
   • Sports participation; or
   • Travel purposes.
   
   Humana commercial group members are encouraged to check their plan documents for more details about their coverage.
   
   To learn how Humana is complying with the federal at-home, over-the-counter COVID-19 test kit requirements, visit the COVID-19 Testing FAQs.
   
   
4. Members may have several options for prescription delivery.
   Members may be able to have their prescriptions delivered. Check with CVS, Walgreens and other local pharmacies to see if they offer local prescription delivery. As an alternative, providers can discuss with their patients about using a network mail order pharmacy. CenterWell Pharmacy’s™ (formerly Humana Pharmacy) mail-order service also includes 90-day supplies. See www.CenterWellPharmacy.com/prescriber-information.html for prescribing information. Other pharmacies available in our network.
   
   
5. Early prescription refills were allowed during the federally declared PHE.
   Humana allowed early refills on prescription medicines for Medicaid members and Medicare members with Part D prescription drug coverage, including both MAPD and PDP members, so they could prepare for extended supply needs—an extra 30- or 90-day supply as appropriate. This did not apply for MA-only members.
   
   

2022 Benefits

1. For 2022, Medicare Advantage, Commercial and Medicaid benefits included no copays, deductibles or coinsurance for all FDA-authorized COVID-19 vaccines and their administration.
   Members received the COVID-19 vaccine with no out-of-pocket costs. This applied when the vaccine was administered by either an in-network or out-of-network provider. Please refer to Humana’s COVID-19 Vaccine policy and COVID-19 Vaccine FAQ, PDF opens in new window for further information. Medicaid plans continued to follow state requirements for COVID-19 vaccines.
   
   
2. For 2022, Medicare Advantage benefits included no member cost share for in-network telehealth visits for primary care, urgent care and behavioral health.
   MA members were not responsible for paying copays, deductibles or coinsurance for the telehealth visits outlined above. For specialty telehealth visits, please verify member plan benefits as any applicable member cost-share would apply. Please refer to Humana’s Telehealth and Other Virtual Services During the COVID-19 PHE policy, for further information. Medicaid plans followed state requirements for telehealth services.
   
   
3. For 2022, Medicare Advantage benefits included no member cost share for COVID-19 treatment.
   MA members had no copays, deductibles or coinsurance for covered services for treatment of active, confirmed cases of COVID-19. Members are encouraged to check their plan documents for details about their 2022 coverage. Please refer to Humana’s COVID-19 Treatment FAQs, PDF for further information. Medicaid plans followed state requirements for COVID-19 treatment.
   
   
4. For 2022, Medicare Advantage benefits included no member cost share on covered COVID-19-related testing and related services.
   
   Humana Medicare Advantage and Medicaid members:
   During the PHE, there were no out-of-pocket costs for Humana Medicare Advantage and Medicaid members who received a FDA or emergency use authorized COVID-19 test that was performed by a laboratory, when the test was ordered by a physician or other licensed healthcare professional. Medicare covered one lab-performed test per member without an order. Testing locations may have required an order or prescription. It was recommended that members contact the testing location for details.
   
   Humana commercial group members:
   Humana commercial group members (those who receive insurance through their employers) were eligible for COVID-19 testing with no out-of-pocket costs when a FDA or emergency use authorized COVID-19 test (including at-home tests) had been ordered by a physician or other licensed healthcare professional because the member:
   
   
   • Had COVID-19 symptoms,
   • Had been exposed to someone with suspected or confirmed COVID-19, or
   • Required pre-admission or pre-procedural testing in an asymptomatic individual.
   
   Humana commercial group members were NOT eligible for coverage of COVID-19 testing for any indications other than those listed above including, but not limited to, the following:
   
   
   • Employment (e.g., pre-employment, return to work) or school purposes (e.g., return to school);
   • Entertainment purposes (e.g., prior to a concert or sporting event);
   • General population or public health screening;
   • Physicals (executive or routine);
   • Screening in a congregate setting;
   • Sports participation; or
   • Travel purposes.
   
   Humana commercial group members are encouraged to check their plan documents for more details about their 2022 coverage.
   
   To learn how Humana is complying with the federal at-home, over-the-counter COVID-19 test kit requirements, visit the COVID-19 Testing FAQs.
   
   

2021 Benefits

1. For 2021, Medicare Advantage, commercial and Medicaid benefits included no copays, deductibles or coinsurance for all FDA-authorized COVID-19 vaccines and their administration.
   
   Members received the COVID-19 vaccine with no out-of-pocket costs. This applied when the vaccine was administered by either an in-network or out-of-network provider. Please refer to Humana’s COVID-19 Vaccine policy and COVID-19 Vaccine FAQ, PDF opens in new window for further information.
   
   The Centers for Medicare & Medicaid Services determined that coverage for COVID-19 vaccines administered to Medicare Advantage plan members was provided through the Original Medicare program in 2021. All claims for vaccines administered to a Humana Medicare Advantage member for dates of service in 2021 should be submitted to the Medicare Administrative Contractors.
   
   Medicaid plans followed state requirements for COVID-19 vaccines.
   
   
2. For 2021, Medicare Advantage benefits included no member cost share for in-network telehealth visits for primary care, urgent care and behavioral health.
   
   Members were not responsible for paying copays, deductibles or coinsurance for the telehealth visits outlined above. For specialty telehealth visits, please verify member plan benefits as any applicable member cost-share would apply. Please refer to Humana’s Telehealth and Other Virtual Services During the COVID-19 PHE policy, for further information. Medicaid plans followed state requirements for telehealth services.
   
   
3. For 2021, Medicare Advantage benefits included no member cost share for COVID-19 treatment.
   
   Members had no copays, deductibles or coinsurance for covered services for treatment of active, confirmed cases of COVID-19. Members are encouraged to check their plan documents for details about their 2021 coverage. Medicaid plans followed state requirements for COVID-19 treatment.
   
   
4. For 2021, Medicare Advantage benefits included no member cost share on covered COVID-19 testing and related services.
   
   Humana Medicare Advantage and Medicaid members:
   There was no out-of-pocket costs for Humana Medicare Advantage and Medicaid members who received a US Food & Drug Administration (FDA) approved or emergency use authorized COVID-19 test.
   
   Humana commercial group members:
   Humana commercial group members (those who receive insurance through their employers) were eligible for COVID-19 testing with no out-of-pocket costs when an FDA approved or emergency use authorized COVID-19 test (including at-home tests) was ordered by a physician or other licensed healthcare professional because the member:
   
   
   • had COVID-19 symptoms,
   • had been exposed to someone with suspected or confirmed COVID-19, or
   • required pre-admission or pre-procedural testing in an asymptomatic individual.
   
   Humana commercial group members may NOT have been eligible for coverage of COVID-19 testing for any indications other than those listed above including, but not limited to, the following:
   
   
   • Employment (e.g. pre-employment, return to work) or school purposes (e.g. return to school);
   • Entertainment purposes (e.g. prior to a concert or sporting event);
   • General population or public health screening;
   • Physicals (executive or routine);
   • Screening in a congregate setting;
   • Sports participation; or
   • Travel purposes.
   
   Humana commercial group members are encouraged to check their plan documents for more details about their 2021 coverage.
   
   

2020 Benefits

1. For 2020, Medicare Advantage, commercial and Medicaid benefits included no copays, deductibles or coinsurance for all FDA-authorized COVID-19 vaccines and their administration.
   
   Members received the COVID-19 vaccine with no out-of-pocket costs. This applied when the vaccine was administered by either an in-network or out-of-network provider. Please refer to Humana’s COVID-19 Vaccine policy for further information.
   
   The Centers for Medicare & Medicaid Services determined that coverage for COVID-19 vaccines administered to Medicare Advantage plan members was provided through the Original Medicare program in 2020. All claims for vaccines administered to a Humana Medicare Advantage member for dates of service in 2020 should be submitted to the Medicare Administrative Contractors.
   
   Medicaid plans followed state requirements for COVID-19 vaccines.
   
   
2. Member cost share for all in-network primary care visits was waived for 2020 to encourage members to seek needed care from their primary care physician.
   
   This applied to Humana Medicare Advantage members. Cost share waivers were retroactively effective as of May 1, 2020. These cost-share waivers applied to office visits for all participating/in-network providers as well as any labs performed in the PCP’s office during the visit. Labs drawn in the PCP’s office and sent to a hospital or reference lab were excluded from the primary care cost-share waiver, as are radiology, supplies and Medicare Part B drugs administered as part of the visit.
   
   
3. Member cost share for outpatient behavioral health visits was waived for 2020 to encourage members to seek needed behavioral health care.
   
   This applied to Humana Medicare Advantage members. We waived all member cost share on outpatient, non-facility-based behavioral health visits with participating/in-network providers. This included psychiatric medication consults, individual therapy and group therapy. These cost-share waivers were retroactively effective as of May 1, 2020.
   
   
4. Member cost share for in-network telehealth visits was waived for 2020 to give members flexibility to seek and receive care.
   
   This applied to Humana Medicare Advantage, fully-insured group commercial, and some self-insured group commercial members. This waiver applied to telehealth visits with all participating/in-network providers, including primary care, behavioral health and other specialist providers. These cost-share waivers were retroactively effective as of March 6, 2020. Medicaid plans followed state requirements for telehealth services.
   
   
5. Member cost share on covered COVID-19-related testing was waived for 2020.
   
   This applied to Humana Medicare Advantage, Medicare Supplement, fully-insured group commercial and self-insured group commercial members. This applied to COVID-19 testing and related services, including laboratory testing, specimen collection and certain related services that result in the ordering or administration of the test, including physician office or emergency department visits. This was limited to the cost share for the coverage provided by the plan, e.g., medical cost only for Medicare Supplement. This cost-share waiver applied on a retroactive basis to services delivered on or after Feb. 4, 2020. Medicaid plans followed state requirements for COVID-19 testing.
   
   
6. Member cost for COVID-19 treatment was waived for some members in 2020.
   
   This applied to Humana Medicare Advantage, Medicare Supplement, fully-insured group commercial, and some self-insured group commercial members. Eligible members had no copays, deductibles or coinsurance for covered services for treatment of confirmed cases of COVID-19. This was limited to the cost share for the coverage provided by the plan, e.g., medical cost only for Medicare Supplement. This cost-share waiver applied on a retroactive basis to services delivered on or after Feb. 4, 2020. Medicaid plans followed state requirements for COVID-19 treatment.