COVID-19 coverage in Rhode Island

Last updated January 29, 2024

Important updates

• Member Cost-Sharing Update: If you are enrolled in a high-deductible health plan, the Internal Revenue Service requires COVID-19 testing and treatment to apply to the deductible starting with your plan's 2024 coverage effective date. If your coverage effective date was January 1, 2024, this requirement will take effect January 1, 2025. 
• Coverage Update: Over-the-counter, at-home tests are no longer covered as of May 12, 2023. The federal public health emergency ended on May 11, 2023. 

COVID-19 coverage

Tufts Health Plan covers these services for COVID-19 when medically necessary and in accordance with plan documents and applicable Rhode Island and federal law.

Please note: Coverage may vary if you’re enrolled in a self-insured group health plan. Check with your employer for coverage details. 

• COVID-19 vaccines¹
  • In network: Covered in full
  • Out of network: Member cost sharing applies²
• COVID-19 tests administered by providers
  • In network: Covered in full³
  • Out of network: Member cost sharing applies²
• COVID-19 treatment and COVID-19 related telemedicine
  • In network: Member cost sharing applies²
  • Out of network: Member cost sharing applies²
• Prior authorization
  • Tufts Health Plan is also reinstating prior authorization for services that require it

Antiviral medications

The FDA has authorized the following two oral antiviral medications under emergency use authorization (EUA) for the treatment of certain cases of COVID-19. When prescribed and dispensed under the requirements of the EUA, one course of therapy can be provided at no charge to the member. Prescriber and pharmacy access is currently extremely limited; speak to your health care provider if you test positive for COVID-19 and believe you qualify for treatment.

• Pfizer’s PAXLOVID™ (nirmatrelvir/ritonavir)
• Merck’s molnupiravir

1. In accordance with federal requirements, in-network COVID-19 vaccines are always covered in full, without member cost-sharing, and out-of-network COVID-19 vaccines are covered in full only when in-network providers are unavailable (see FAQs 58, Q4). 
2. Member cost sharing includes copayments, deductibles and coinsurance. Only POS and PPO plans have out-of-network benefits.
3. If you are enrolled in a high-deductible health plan, the Internal Revenue Service requires COVID-19 testing and treatment to apply to the deductible starting with your plan's 2024 coverage effective date. If your coverage effective date was January 1, 2024, this requirement will take effect January 1, 2025.