Helping Rhode Island Medicaid Members During the Coronavirus (COVID-19) Pandemic

Tufts Health Plan is committed to giving you updated and reliable information about your health care benefits. This is especially important during the COVID-19 outbreak.

2/8/21 updates:

  • As new treatments are approved for emergency use authorization, they will be subject to the same guidelines as our other COVID-19 treatments. 
  • Members are fully covered to get approved COVID-19 vaccines, medically necessary testing and in-person treatment for COVID-19. This coverage applies for any health care provider within our provider network. It also applies for out-of-network providers if in-network services are not available.



Health care and plan information

Symptoms and possible exposure

If you have symptoms or if you believe you have COVID-19 call your health care provider. People with COVID-19 have had a wide range of symptoms. This may include: a cough, shortness of breath, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat and new loss of taste or smell. This is not a full list. If you have any other symptoms that are severe or concern you, call your provider. Your provider may be able to check in with you by phone or video chat. Contact your provider to see if this option is available. Telehealth for COVID-19 is covered in full at no cost to you.

If your symptoms are mild, call your PCP before you go to the emergency room (ER) or urgent care. Most people who are mildly ill with COVID-19 are able to recover at home. Your close contacts should stay home as well. Do not visit public areas. Follow the CDC’s guidance for separating yourself from others.

If your symptoms get worse, call your health care or urgent care provider before you visit them. Follow any rules that the health care facility has in place. This will help the office staff protect themselves and other patients.

In an emergency, call 911.

Where to find testing for COVID-19

If you are experiencing COVID-19 symptoms or have been exposed to someone that has, you should call your health care provider. You do not need a referral or prior approval (authorization) to get medically necessary testing or treatment related to COVID-19. Based on where you live, you can find a location near you to get tested for COVID-19. Just click one of the links below to search for a location.

Please call ahead to check the rules for each location before you seek a test.

Testing locations:

Call us at 866-738-4116 (TTY: 711) if you are having trouble finding a network provider.

Testing for COVID-19 is only covered for reasons that are medically necessary. Tufts Health Plan will not cover testing for COVID-19 for reasons solely related to travel, work or school.

Members are covered for antibody testing when testing is determined by a primary care provider (PCP) or other provider to be medically necessary. According to the Centers for Disease Control and Prevention (CDC), these blood tests look for antibodies that show you previously were infected with the virus that causes COVID-19. These tests do not test for current infection. Please contact your PCP or other provider to find out whether this testing is appropriate for you.

Vaccinations

The U.S. Food and Drug Administration (FDA) has approved several COVID-19 vaccines. A vaccine will be available to all individuals free of charge (as required by the CARES Act). That means there will be no cost to you when you get the COVID-19 vaccine. Keep in mind that:

  • Early supplies of the vaccine are limited.
  • States are determining eligibility.
  • We are hopeful that over the next few months, most high-risk groups will have had an opportunity to be vaccinated.

The current, approved vaccines require two doses. You will need to take both doses for the vaccine to be fully effective.

For information on the Rhode Island vaccination timeline, visit https://covid.ri.gov/vaccination.

Be aware of vaccine scams

As COVID-19 vaccine distribution begins, be aware that scams are starting to emerge. It’s important to know what signs to watch for, including:

  • If you are asked to pay out-of-pocket to get the vaccine.
  • If you are asked to pay to put your name on a vaccine waiting list or to get early access.
  • If marketers offer to sell or ship doses of the vaccine for payment.
  • If you are asked for any personal information (such as Social Security Number (SSN), Medicaid ID (MID), etc.).

Learn more about how to protect yourself and report potential COVID-19 fraud here

Costs and coverage—COVID-19 related

For our Tufts Health RITogether (Medicaid) members, we have changed our coverage rules. These changes will help you get testing and treatment more easily. Until further notice:

  • As new treatments are approved for emergency use authorization, they will be subject to the same guidelines as our other COVID-19 treatments.
  • As vaccines for COVID-19 are approved and available, the vaccines will be covered in full. There will be no cost to members. 
  • Members are fully covered to get telehealth from network providers. Telehealth is when you receive health care services by phone, video or another technology from a primary care provider or a specialist. Contact your provider to see if telehealth is available.

Call member services at 866-738-4116 (TTY: 711) if you have questions about your coverage.

Referrals

Members should continue to see providers in their network whenever possible. Prior authorization may be required for an out-of-network service that is not related to COVID-19. Members do not need a referral from their primary care provider to see in-network specialists.

Children’s vaccines and wellness visits

During the COVID-19 outbreak, it’s still important for children to get their immunizations. Immunizations protect your kids from preventable diseases. Measles, mumps and whooping cough are just some of the illnesses we can prevent through vaccines. Providers’ offices are taking steps to see kids in a safe and controlled way when they need an in-office visit.

Call your child’s primary care provider. Make a plan to keep your child on schedule for their immunizations safely. Preventive visits and immunizations are covered at no cost to members.

Prescriptions and medications

We allow members an early refill of their prescriptions before the expiration date as long as there are refills on the medication. We want to make sure that members have a supply of their medications if they need them.

Members can refill up to a 90-day supply if permitted for that type of medication. Early refills will not be allowed for controlled substance drugs.

If you have multiple maintenance medications, each drug can be refilled early just once.


Virtual health care

Telehealth

Members are fully covered to get telehealth from network providers. Telehealth is when you receive health care services by phone, video or another technology from a primary care provider or a specialist. Contact your provider to see if telehealth is available.

24-Hour NurseLine

If you have questions about COVID-19 or any health issue, call our free NurseLine at 800-285-3580. You can speak to a registered nurse anytime, 24 hours a day, seven days a week.


 

COVID-19 Guidance From the Rhode Island Department of Health

  • Avoid close contact with people who are sick. Practice social distancing by staying 6 feet away from others and wear facial coverings in public.
  • Limit social contact to only the people in your household.
  • Be sure you have over-the-counter medicines and medical supplies (tissues, etc.) to treat fever and other symptoms. Most people will be able to recover from COVID-19 at home.
  • Pay attention for potential COVID-19 symptoms, including, fever, cough and shortness of breath. If you feel like you are developing symptoms, call your health care provider.
  • More information is available from the CDC.
  • People with general questions about COVID-19 can visit https://health.ri.gov/covid, write to RIDOH.COVID19Questions@health.ri.gov, or call 401-222-8022. This is the COVID-19 Hotline that RIDOH has available to the public. (After hours people are being directed to call 211.)
  • Everyone can help stop the spread of viruses in Rhode Island.
  • Get your flu shot, and make sure the people around you do the same.
  • Wash your hands often throughout the day. Use warm water and soap. If soap and water are not available, use alcohol-based hand gel.
  • Cough or sneeze into a tissue or your elbow. Viruses can spread by coughing or sneezing on other people or into your hands.
  • Stay home from work or school if you are sick.
  • Avoid touching your eyes, nose or mouth. Germs spread this way.