Coronavirus Update

Update: Coverage for over-the-counter, at-home COVID-19 tests ends after May 11, 2023.

We are covering the cost of up to eight over-the-counter, at-home COVID-19 tests per member, per month for Tufts Health Direct members. We will pay only for tests that are approved by or granted emergency use authorization by the FDA, are intended for individualized diagnosis or treatment of COVID-19 (not for resale) and are not for employment purposes.

View a List of Eligible Tests

Through May 11, 2023, Direct members can visit the following pharmacies and purchase the tests with no upfront cost:

• Sam’s Club

• Bartell Drugs

• Maxi Drug, Inc.

• Eckerd Drug Stores

• Kinney Drugs

• Kmart Corp

• Walgreens

• Walmart

• Rite Aid

Direct members paying for at-home tests out-of-pocket can also submit a form for reimbursement through OptumRx, our pharmacy benefit manager. Members can submit an online reimbursement form, or they can complete a paper reimbursement form and mail it with their receipts to OptumRx for any tests purchased on or after January 1, 2023. Please see the forms for instructions. Members submitting reimbursement for tests purchased before this date will need to submit for reimbursement from CVS/Caremark. 

Direct members who paid for at-home tests out-of-pocket between January 15, 2022 and December 31, 2022 can also submit a form for reimbursement through CVS Caremark. Members can submit an online reimbursement form through their accounts on www.caremark.com, or they can complete a paper reimbursement form and mail it with their receipts to CVS Caremark. Please see the forms for instructions and details.

We will only pay for eligible tests from originating retailers that are not resellers and are purchased on or after January 15, 2022. (Examples of resellers that are ineligible for reimbursement include Ebay, Craigslist, OfferUp, Shopify, Facebook Marketplace and Bonanza).

We also cover in-person PCR (polymerase chain reaction), antigen and antibody laboratory testing consistent with federal and state guidance at no cost to our members. These tests must be medically necessary, as determined by a health care provider, in accordance with current CDC and state public health department guidelines.

COVID-19 PCR tests that are laboratory processed and either conducted in person or at home must be ordered or referred by a provider to be covered benefits. We will not cover or reimburse you for these tests when you order them yourself, including when you order using an online self-completed questionnaire. Testing is not covered solely for general workplace health and safety, public health surveillance or for other purposes not primarily intended for a member’s individual COVID-19 diagnosis or treatment. Diagnostic coronavirus testing required as a condition of travel inside or outside of the United States is not covered.

Diagnostic testing required by your provider for surgical or other medical procedures is medically necessary and covered, including if you are pregnant or an expectant parent and testing is required prior to admittance to a delivery facility. As always, coverage is only available to health plan members.

Updates to our current COVID-19 testing policies will be published to this site as they become available.

Until further notice, the following is in place for all Tufts Health Direct members:

• As new treatments are approved for emergency use authorization, they will be subject to the same guidelines as our other COVID-19 treatments.
• COVID-19 vaccines that are FDA-approved and available are covered in full. There will be no cost to members. For more information visit our COVID-19 Symptoms and Testing webpage.
• We are waiving member cost share (including copayments, coinsurance and deductibles) for medically necessary COVID-19 testing and treatment. This coverage applies with in-network providers or at in-network facilities, and at out-of-network providers or facilities in the event a member cannot easily find an in-network provider to provide timely services.
• There are no out-of-pocket costs for COVID-19 antibody testing when testing is determined by a primary care provider (PCP) or other provider to be medically necessary. Please contact your PCP or other provider to find out whether this testing is appropriate for you. This coverage applies at in-network providers, urgent care, emergency rooms and other facilities, and at out-of-network providers in the event a member cannot easily find an in-network provider to provide timely services. Consistent with federal and state guidance, coronavirus tests will only be covered or reimbursed if they are medically necessary. They will not be covered solely for the following reasons:
  • Members need a COVID-19 test to travel;
  • Members need a COVID-19 test to return to work;
  • Members need a COVID-19 test for school, sports, etc.;
  • Members feel they need a COVID-19 test to visit other individuals;
  • Members believe they have had or possibly had exposure to COVID 19 positive individuals—except if they have been identified as a close contact by the state, a state agency or a healthcare provider
  • Members would like to know their COVID-19 status.
• Telehealth services are covered as follows:
  • For service received through July 20, 2020: We waived all member cost share (copayments, coinsurance and deductible charges) for any in-network telehealth services or out-of-network telehealth services.
  • For services received after July 20, 2020: Out-of-network Pre-COVID-19 standard benefits (including applicable cost share) apply and out-of-network telemedicine services are not covered unless specifically authorized by the plan. 
  • For services received after December 31, 2020: Member cost share will be reinstituted for all non-COVID-19 telehealth services.

When members travel outside the U.S., only emergent/urgent care is covered.

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

• Call member services at 888-257-1985 (TTY: 711) if you have questions about out-of-network coverage.
• Members should continue to see providers in their network whenever possible. Prior authorization is required for any out-of-network service that is not related to COVID-19.

During COVID-19, it’s still important for children to get their immunizations. Make sure you protect your kids from preventable diseases. Measles, mumps and whooping cough are some of the illnesses we can prevent through vaccines.

Call your child’s primary care provider. Make a plan to keep your child on schedule for their immunizations safely. Providers’ offices are taking steps to see kids in a safe and controlled way when they need an in-office visit. Preventive visits and immunizations are covered at no cost to members.

Many providers offer telehealth services. Ask your primary care provider if they do. This also includes telephone consultations. Telehealth enables members to make inquiries regarding symptoms or treatment for the coronavirus in order to reduce the need for members to go to medical offices where the risk of coming in contact with the coronavirus may be higher.

Telehealth services are covered as follows:

• For service received through July 20, 2020: We waived all member cost share (copayments, coinsurance and deductible charges) for any in-network telehealth services or out-of-network telehealth services.
• For services received after July 20, 2020: Out-of-network Pre-COVID-19 standard benefits (including applicable cost share) apply and out-of-network telemedicine services are not covered unless specifically authorized by the plan. 
• For services received after December 31, 2020: Member cost share will be reinstituted for all non-COVID-19 telehealth services.

Tufts Health Direct offers access to a 24/7 NurseLine. Call 888-697-6546 to speak to a registered nurse to receive medical advice on appropriate care.

You can also call your provider with questions. If it’s an emergency, call 911.

If you're enrolled in a ConnectorCare plan and are experiencing difficulty paying your monthly premium due to financial hardship caused by the COVID-19 pandemic, you may be eligible for a Health Connector hardship waiver.

Learn more at Premium Payment Help Options – Massachusetts Health Connector.