For our Tufts Health RITogether (Medicaid) members, we are changing our coverage rules. These changes will help you get testing and treatment more easily.
Until further notice:
- If a vaccine for COVID-19 is approved and available, the vaccine will be covered in full. There will be no cost to members.
- Members are fully covered to get 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.
- 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. Please contact your PCP or other provider to find out whether this testing is appropriate for you.
- 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.
- Members and families who get respite services can get added support. Starting March 16, 2020, the plan covers up to 200 hours of respite services.
- 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.
- Call member services at 866-738- 4116 (TTY: 711) if you have questions about out-of-network coverage.
If you have questions about your coverage, we can help. Call the Member Services number on your member ID card.
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.
Childhood Immunizations: Keep up with Your Child’s Immunizations
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.
When and How to Get Care
Here are some steps you can take:
- 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.
- If you have symptoms or if you believe you have COVID-19, call your 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 list 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 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.
More information about COVID-19 is available in multiple languages here.
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 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.
Call us at 866-738-4116 (TTY: 711) if you are having trouble finding a network provider.
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. Do not gather in groups of more than 15 people.
- 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.
For more information, visit the CDC and the Rhode Island Department of Public Health websites.