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Coronavirus Information for Medicare Members

Information Specific to Medicare Members

Below you will find useful information about the virus specifc to Medicare members.

If you have any questions feel free to reach out using the contact information listed throughout this page. You can also contact our member experience team.

Frequently Asked Questions about the Coronavirus Vaccine

Yes, the U. S. Food and Drug Administration (FDA) authorized the Pfizer BioNTech vaccine for emergency use for people age 16 and older. The FDA created a fact sheet with additional information about the safety and recommended use of the Pfizer BioNTech vaccine.

Moderna has also been granted emergency use authorization from the FDA for people age 18 and older. The FDA created a fact sheet with additional information specific to the Moderna vaccine.

More companies are expected to apply for this authorization in the upcoming months, which would increase the availability of the vaccine.

Limited quantities of the vaccine will be available at first and it will be administered based on data provided by the Centers for Disease Control and Prevention (CDC), state sources and local health departments.

According to the Wisconsin Department of Health Services, the Phase 1 vaccines will be offered to these individuals.

  • Phase 1A
    • Health care personnel exposed to or treating people with coronavirus
    • People living in long-term care or assisted living facilities
    • Wisconsin Department of Health Services expects it to take several months to vaccinate everyone eligible for Phase 1A
  • Phase 1B
    • People age 75 and older and non-health care front line essential workers (such as firefighters, police officers, etc.)
    • The timeframe of Phase 1B is unknown at this time

The CDC's director, Dr. Robert Redfield, has indicated that the vaccine may be available to the general public as soon as late spring or early summer. This may change if more companies receive additional emergency use authorizations from the FDA.

The CDC released Phase 1C of the vaccine rollout plan, which includes these individuals.
  • People age 65 through 74
  • People age 16 through 64 with underlying medical conditions
  • Other essential workers, such as people who work in food service, information technology, media, public safety and public health

The CDC has directed individual states to oversee the vaccine distribution process, so we are waiting on further instructions from the Wisconsin Department of Health Services. We will update our website as we receive additional information and direction.

You can check the Wisconsin Department of Health Services website for the most up-to-date information about when the vaccine will be available. You should speak with your personal doctor about his/her recommendations for you to receive the coronavirus vaccine.
  • At this time, there isn't a vaccine list or sign-up process in place to receive the vaccine in the state of Wisconsin
  • The CDC directed individual states to oversee the vaccine distribution process
  • The Wisconsin Department of Health Services is doing a phased approach
    • We are currently in Phase 1A of the distribution process
    • We will update our website as we receive additional information and direction
  • We have open lines of communication with our local providers, including retail pharmacies, clinics and hospitals—once the vaccine is more widely available we will determine next steps
  • The CDC directed individual states to oversee the vaccine distribution process
  • You can refer to the health department website for the state where you live during the winter months to find that state's vaccine availability and distribution

The safety of the coronavirus vaccine is a top priority. This vaccine had to go through the same approval process as any other vaccine. The FDA only authorizes a vaccine when the expected benefits outweigh the risk. You can learn about how the FDA, CDC and other government bodies are working together to ensure the safety of the vaccine.

There are three major reasons the vaccine was developed more quickly than other vaccines.

  1. Developing the vaccine was a global effort—the world's top scientists were all focused on it at the same time
  2. Access to nearly unlimited money, knowledge, manpower and technology
  3. Many diverse adults volunteered as trial participants.

The coronavirus vaccine is an mRNA vaccine, not a conventional vaccine. mRNA technology is new in vaccine production, but has been studied in cancer treatments for over ten years.

Conventional vaccines, like the annual flu vaccine, need the virus to be inactivated in a lab first. This can take months to years to develop.

mRNA vaccines are made in lab, without having the virus present. The coronavirus mRNA vaccine causes our cells to create a spike protein. This is a harmless protein that is found on the surface of the coronavirus. Once it's in our system, our body realizes it shouldn't be there, so it creates antibodies to fight the virus if we're infected in the future.

Froedert and the Medical College of Wisconsin has a webpage with more information about the safety and development of the coronavirus vaccine.

The FDA's Pfizer BioNTech fact sheet and Moderna fact sheet are the best sources for information about protection, safety and side effects of each vaccine.

According to the FDA, these vaccines have been shown to prevent the coronavirus when two doses are given three to four weeks apart. The duration of this protection is still unknown.

According to the New England Journal of Medicine, the two-dose Pfizer vaccine indicates 95 percent protection against the coronavirus in people age 16 and older. The two-dose Moderna vaccine provides 94.1 percent protection against the coronavirus in people age 18 and older.

This level of protection occurs one to two weeks after the second dose of the vaccine.

Yes, since we don’t know how long someone who has already been infected is protected and how long protection lasts, we believe the recommendation will be to get vaccinated even if you previously had coronavirus.
The current vaccine studies have only included individuals above 16. At this time, it is unknown when the coronavirus vaccine will be available to children.
The Wisconsin Department of Health Services will have information about where to get the vaccine, once it's available. As availability increases, you will be able to get the vaccine at participating local retail pharmacies.

Network Health Medicare Advantage Plan members can get the vaccine at a $0 out-of-pocket cost, including both doses, and it doesn't matter where you receive it.

Make sure you bring your red, white and blue Medicare card, because you'll be required to show it to receive your vaccine.

No, masks and social distancing will still be recommended after people begin getting vaccinated.

According to the CDC, herd immunity happens when enough people have protection—either from previous infection or vaccination—that is unlikely a virus or bacteria can spread and cause disease

  • As a result, everyone within the community is protected even if some people don’t have any protection themselves
  • The percentage of people who need to have protection in order to achieve herd immunity varies by disease
    • Scientists initially estimated that 70 percent of the population needed to acquire resistance to the coronavirus to prevent further spread—this estimate requires further research

Viruses constantly change through mutation, and new variants of any virus are expected to occur over time. Sometimes new variants emerge and disappear. Other times, new variants emerge and start infecting people.

  • Multiple variants of the virus that causes the coronavirus have been documented in the United States and globally during this pandemic
  • The variant B.1.1.7 seems to spread more easily and quickly than other variants
    • Currently, there is no evidence that this strain causes more severe illness or increased risk of death
    • For more information on this variant, please check the CDC website
The CDC has created a page to help you learn about the vaccine. It's titled 8 Things to Know about the U.S. COVID-19 Vaccination Program.

 Medical Plan Information About the Coronavirus

Network Health will waive out-of-pocket costs for the lab test and any primary care, urgent care or emergency room visits related to obtaining the coronavirus test, in accordance with the Families First Coronavirus Response Act.

In addition, if you are outside the Network Health service area and you receive the lab test, we are not requiring a prior authorization (prior approval) for the lab test.

You can contact your personal doctor, Wisconsin Department of Health Services at dhs.wisconsin.gov/outbreaks/index.htm, Ascension, Froedtert or visit the CDC’s website at cdc.gov/coronavirus/2019-ncov/index.html.

If you are feeling mildly ill, call your doctor before seeking medical treatment.

  • He or she may be able to give you advice on how to treat your symptoms at home, which would reduce the number of people you expose.
  • If you or someone you’re caring for is short of breath, minimally responsive, looks blue or ashen call 911.
Providers will prioritize who is tested. Here is some of the criteria that will be used.
  • Patients with signs and symptoms of the coronavirus (such as fever, cough and difficulty breathing) and no other explanation for symptoms.
  • High risk patients (individuals with underlying health conditions such as asthma, diabetes, cancer or heart disease, age = 65, residing in a long-term care facilities, etc.).
  • Patients with known or suspected contact (direct contact with a known case of the coronavirus, travel history to a high-risk geographic area or healthcare worker with known exposure) within the past 14 days.
If your provider determines you need a test, they will work with you on what to do next. Typically, that means your doctor will collect a sample via swabbing the nose and throat before sending to a state-regulated lab.
Yes, all Network Health members can get a 90-day supply of their medications if the following conditions are met.
  • The prescription order has sufficient refills remaining. If needed, ask the pharmacist to request additional refills from your prescriber.
  • The requirements for taking these medications imposed by the medication prescriber are met.
  • This applies to our entire pharmacy network, including states outside Wisconsin.

Medicare members can get their refills via retail location or mail order.

During the coronavirus health crisis, members may reach out to their pharmacy to ask about delivery options. Many pharmacies are delivering free of charge while Wisconsin is under the safer at home order.

At this time, no changes are anticipated to member medical or pharmacy benefits. We are monitoring the situation closely and will update our information and policy if the situation changes.
Yes, hydroxycholorquine is on our drug list. Our pharmacy benefits manager is putting an anti-hoarding algorithm into their system to monitor supplies because we understand how important this drug is for chronic disease management.

Telehealth Services

To give our members access to the care they need, effective March 20, 2020, Network Health will cover all coronavirus telehealth services for a $0 copayment, including MDLIVE® virtual visits and telephone and virtual face-to-face visits with in-network providers.

Currently, all coronavirus telehealth services will be covered at a $0 copayment through April 20, 2021, but we will continue to evaluate that date based on guidance provided by CMS.

All telehealth services for CMS-approved providers and covered services are covered at a $0 copayment, including MDLIVE. 

We will not cover Medicare telehealth visits for providers who are not allowed to bill for telehealth services for Medicare members.

No. To increase access to appropriate care, all coronavirus telehealth visits will be covered at $0 per visit until April 20, 2021, even before members have met their deductible.

No, primary care telehealth services are not subject to your plan’s deductible, copayment and/or coinsurance until April 20, 2021.

Virtual visits limit your exposure to illness from others and limit the spread of any illness you may have. Getting medical advice using a virtual visit provides many benefits if you are experiencing non-emergency symptoms. For more information on MDLIVE, including the illnesses they treat and instructions for logging in, visit our Getting Care Quickly page.

Please note, due to increased activity, MDLIVE wait times are longer than usual. If you prefer not to wait on hold, MDLIVE gives you the option to receive a call back.

Yes, all telehealth services for CMS-approved providers and covered services are covered at a $0 copayment. This applies to all telehealth providers for preferred provider organization (PPO) plans and in-network providers for health maintenance organization (HMO) plans. HMO plans do not cover telehealth services with out-of-network providers.

We will not cover Medicare telehealth visits for providers who are not allowed to bill for telehealth services for Medicare members.

Below is a list of providers that have telehealth services available online. This list will continue to grow as we get more information.

Yes, this list will continue to grow as we get more information.

  • Froedtert 414-805-2000
  • Ascension 833-978-0649
  • Agnesian 844-225-0147
  • Bellin Health 888-330-3524
  • Bellin Telehealth 920-445-7313
  • Holy Family 920-320-3333
  • Primary Care Associates of Appleton 920-996-1000
  • ProHealth 262-928-4499

That is at the discretion of the provider. Typically, providers will only see existing patients virtually.

No, the coronavirus must be diagnosed through a lab test. Telehealth providers can let their patient know whether a lab test is warranted.

Medicare is allowing coverage of some tests with no member responsibility when the purpose of the visit was to evaluate for possible Coronavirus infection.

This depends on the pharmacy, so the member will want to call the pharmacy to confirm. During the coronavirus health crisis, many pharmacies are delivering free of charge while Wisconsin is under the safer at home order.

In addition, many pharmacies have drive-up windows that customers can use, if they don't want to enter the store.


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Menasha, WI 54952
Hours
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Tuesday: 8 a.m. to 4 p.m.