Last Updated 10/25/21
Coverage for COVID-19 Testing: When, where, and how it is covered
When, where, and how it is covered
There are different testing options depending on your needs:
- If you have symptoms and need a diagnostic test, or if you need a test before a surgery or medical procedure: See “When COVID-19 Testing is covered.”
- If you need tests for screening purposes: See “When COVID-19 Testing is not covered.”
- If your child is a student or if you are a school staff member who may have symptoms of COVID-19 and needs a test before returning to school: See “Testing Information for Students and their Parents.”
When COVID-19 Testing is covered
- For diagnosis of COVID-19: Independent Health covers diagnostic testing when you or your health care provider decide you need test to see if you have COVID-19. Diagnostic tests show whether a person has the COVID-19 virus and the possibility of infecting others.
- Pre-surgical testing: A COVID-19 test needed before a surgery or medical procedure is covered.
When Covid-19 Testing is not covered:
Independent Health does not cover Covid-19 testing for screening purposes, such as:
- Test required by an employer, or to attend school (both students and staff) in the absence of symptoms or a known exposure
- To attend events such as weddings, sports games, concerts, camps and other entertainment, and for travel purposes (domestic and international, including Canada)
- To participate in a sport or team activity
- Public health surveillance
Our testing policy is consistent with other health plans across New York State.
Members of our self-funded plans should contact us at (716) 631-2661 or 1-800-257-2753 for specific information about how their plans cover testing. The back of your member ID card indicates “Medical benefits administered by Nova.”
To get a screening test for the reasons above, you may make an appointment to get tested at a New York State or county testing site.
- Erie County residents: Call 716-858-2929
- New York State testing sites: Call 1-888-364-3065
- Residents of other counties: contact your county’s health department for testing information.
We strongly encourage our members to contact their primary care doctor to help them decide if they need diagnostic test.
Members of our State products (MediSource, Essential Plan, Child Health Plus) must use participating in-network provider for these services. (These products follow specific coverage guidelines).
Where to get tested for diagnostic purposes
- Contact your primary care provider’s office first.
- You may get tested at a New York State or county testing site, or urgent care center. Some doctor’s offices, certain pharmacies and all hospitals which participate with Independent Health also offer diagnostic tests.
Testing Information for School Students and their Parents or School Staff
Below are options if a school student or staff member has COVID-19 symptoms and needs a negative test to able to return to school:
Erie County residents:
- For students and staff who have been excluded from school because they are ill and showing symptoms, Erie County offers community-based testing sites that offer FDA-approved NAAT COVID-19 tests that provide results within 15 minutes (availability depends on supply). As with a PCR test, the NAAT is an accepted test for return-to-school purposes.
- Call the Erie County Health Department at 716-858-2929 to schedule an appointment.
- For more information on other testing sites, visit the Erie County Health Department.
- Other testing sites may have longer wait times until you get the test results.
- Individuals who need a test after being exposed to a confirmed case of COVID-19 may also call Erie County at 716-858-2929 to schedule a test.
Residents of other counties: check with your county health department or find a testing site here.
Coverage for Antibody Testing
Antibody testing with an order or prescription from your health care provider is covered. (While CMS regulations do not require a provider’s order for Medicare Advantage members, we encourage providers to discuss the benefit of the test with those members.)
This short video explains the difference between diagnostic and antibody testing
COVID-19 Vaccine Information
Everyone aged 12 years and older is able to get the COVID-19 vaccines. It is one of the most important things you can do to stay healthy. We encourage you to get the COVID-19 vaccine as soon as you can.
We know you might have questions about the vaccine, so we are sharing this information and tips to keep you informed. Choose "Read More" below to learn information about:
- Vaccine coverage
- How to schedule an appointment
- Booster shot
- Unable to leave home? In-home vaccinations available
- Tips on scheduling a vaccine online
- Vaccine safety
- Other important vaccine facts
- The vaccines, including the booster shot, are covered with no cost share.
- If you have Medicare or a Medicare Advantage plan, you may have to give your Medicare number from your red, white and blue Medicare card. This is different than your Independent Health ID number.
How to schedule an appointment for your first dose
New York State guidelines now allow any resident age 12 and over to get a COVID-19 vaccination. Here are different ways to schedule an appointment.
- New York State’s am-i-eligible website.
- Call the COVID-19 Vaccination Hotline at 1-833-NYS-4VAX (1-833-697-4829), Monday through Sunday from 7 a.m. to 10 p.m.
- Visit vaccinehound.org for locations in Allegany, Cattaraugus, Chautauqua, Erie and Niagara counties
- Check vaccinefinder.org for a list of locations in your area.
- Your County’s website may have locations.
- Local pharmacies, including those at supermarkets, are also scheduling vaccine appointments.
COVID-19 vaccine booster shot
People who are moderately to severely immunocompromised should, in most cases, receive another dose of their vaccine. For more information on the types of medical conditions people have and who should get the booster shot, please visit the Centers for Disease Control and Prevention (CDC) website.
If you have questions if you should get a COVID-19 vaccine booster, please speak with your primary care doctor.
At this time, the federal government is reviewing data to see if booster shots are needed for everyone. To stay up-to-date on booster shots, visit the CDC page.
Check the same sites above to find where you can get your booster shot. You do not have to go back to the same place you got your first dose.
Be sure to take your insurance card, Medicare card, and your vaccination card when you go for your booster shot.
Unable to leave your home? In-Home Vaccinations are available
Not everyone is able to travel to one of the many sites that are offering COVID-19 vaccines. New York State, in partnership with counties, has posted information on how to get an at-home vaccine for people who are not able to leave their homes for different reasons to get vaccinated. At-home vaccination is available to people who are not able to leave their homes because they have:
- Physical limitations
- Cognitive impairment (trouble remembering things, learning things or making decisions that affect everyday life)
- Other chronic conditions
- Unable to get a ride to a vaccination location
- Visual impairments (trouble seeing)
- If they do not have access to supports that may help them physically go to an existing vaccination provider.
To learn more about getting vaccinated in your home, visit the New York State vaccine page for information on whom to contact in your county.
Millions of people have received the COVID-19 vaccine safely. The safety of every vaccine used is being watched. For the most up-to-date safety information about the vaccine, visit the Centers for Disease Control and Prevention (CDC) website.
In the video to the right, doctors, nurses and researchers address common questions and misperceptions about the COVID vaccines.
Other important vaccine facts
- COVID-19 vaccination is especially important for people with underlying health problems like heart disease, lung disease, diabetes, and obesity. People with these conditions are more likely to get very sick from COVID-19. Please consult with your health care provider if you have specific questions about the COVID vaccine and your health.
- None of the authorized COVID-19 vaccines contain the live virus that causes COVID-19. This means the vaccine cannot make you sick with COVID-19.
- Even if you have already had COVID-19 and recovered, the CDC recommends you still get vaccinated.
- Visit CDC.gov for a list of frequently asked questions and helpful information about the vaccines.
With the uncertainty everyone is facing, we know our members have many questions. We want you to rest assured that Independent Health’s coverage will be there for you when you need it.
- My coverage
- My Prescriptions
No, health care providers must not charge health plan members for the providers’ use of these supplies (known as Personal Protective Equipment, or PPE). Any provider that has charged their patients fees to cover the cost of PPE must refund those patients in full.
If your provider charged you for those supplies, please contact Independent Health’s member services department using the number on the back of your ID card.
- Independent Health covers all services and treatment for our members with no member cost share, including in-person, telehealth, urgent care center, outpatient hospital or emergency room visits when the primary purpose of the visit is COVID-19 testing, diagnosis and treatment.
- This coverage applies through December 31, 2021 for all fully insured commercial plans (including HSA-qualified high deductible health plans), Medicare Advantage, State Products and Individual plan members.
- Self-Funded Members: Coverage for self-funded employer plans varies by employer group. Members who are Self-Funded through your employer should contact us at (716) 631-2661 or 1-800-257-2753 for your specific coverage. The back of your member ID card indicates “Medical benefits administered by Nova.”
Independent Health covers all laboratory testing and services related to the diagnosis of COVID-19 with no member cost share.
- Members of our State products (MediSource, Essential Plan, Child Health Plus) must use participating in-network provider for these services. (These products follow specific coverage guidelines).
- However, Independent Health does not cover Covid-19 testing for screening purposes, such as:
- Test required by an employer, or to attend school (both students and staff)
- To attend events such as weddings, sports games, camps, concerts and other entertainment, and for travel purposes (domestic and international, including Canada)
- To participate in a sport or team activity
- Public health surveillance
- For information on Antibody testing coverage, please refer to the question “Is COVID-19 antibody testing covered by my plan?”
Telehealth and Telemedicine:
Independent Health covers in-network telehealth/telemedicine services in full with $0 cost-share, when the service is related to COVID-19.
Medicare members are responsible for the cost share associated with ancillary services (e.g. dietitians).
We encourage members to contact their primary care physician for their medical needs, but we also know this isn’t always possible. When you can’t reach your primary care physician, Teladoc* allows members to talk with a doctor anytime, anywhere by phone, mobile app or online 24 hours a day, 7 days a week.
We are currently waiving the cost share for Teladoc services related to COVID-19.
*Teladoc is not available to MediSource, MediSource Connect, Essential Plan and Child Health Plus members.
If you seek treatment for a health issue, illness or injury that is unrelated to COVID-19, you will be responsible for paying the standard copays or coinsurance per your current benefits.
Due to the emergency declaration, Medicare Advantage members may obtain care from out-of-network providers at the in-network cost sharing. For more information, see the page called “Getting care during a disaster.”
At this time, antibody testing is covered with no cost-share if the test is determined to be medically appropriate and ordered by your healthcare provider.
If you are Medicare Advantage member, you do not need an order from your provider but we encourage to speak with your provider about the benefits of testing
If you are a member of State Program or Product (MediSource, Child Health Plus, or Essential Plan): If you are enrolled in a State Program with Independent Health, we strongly encourage you to work with your primary care provider or other healthcare providers who participate with Independent Health to help decide and arrange COVID-19 virus or antibody testing. If it is not an emergency, you have to get your services from in-network providers. Working with in-network providers will help ensure you are not billed in error by providers that do not participate with Independent Health.
If you are a member of a self-funded group: Members who are Self-Funded through your employer should contact us at (716) 631-2661 or 1-800-257-2753 for more information about this coverage. The back of your member ID card indicates “Medical benefits administered by Nova.”
What you need to know about antibody tests
Antibody tests look for past infection with the coronavirus that causes COVID-19. After someone has been infected with the coronavirus, their body usually produces antibodies in response to the infection. Antibodies are proteins that help fight off infections.
Depending on when someone was infected and the timing of the antibody test, the test may not find antibodies in someone’s blood with a current COVID-19 infection, because it can take one to three weeks for antibodies to appear after symptoms occur. This means a person infected with COVID-19 may not yet have developed antibodies, leading to a negative test result.
The CDC has advised that antibody tests should not be used to diagnose an active COVID-19 infection. In addition, medical experts do not know yet if having antibodies to the virus can protect someone from getting infected with the virus again, or how long that protection might last. For these reasons, it is important that you discuss with your primary care provider the value of antibody testing. If your primary care provider orders antibody testing for you, you should be sure to follow up with your provider to discuss your test results and what they may mean.
The lab that conducts the test is required to tell you:
- If the test has not been reviewed by the Food and Drug Administration.
- False negative results can occur. You could have infection not detected by the test.
- False positive results can occur. Positive results may be due to past or present infection with non-COVID-19 coronavirus strains such as the common “cold.”
- Results from antibody testing should not be used as the sole basis to diagnose or exclude COVID-19 infection, or to inform infection status.
No, Independent Health does not cover COVID-19 testing when it is required for students to return to school, for public health surveillance, or for any other purpose not intended to diagnose or treat an individual.
Free testing is available to the public through the New York State Department of Health and each county’s health department.
You must check with your health care provider to determine if the test is medically appropriate.
Many doctors’ offices offer telehealth visits so they can treat their patients by phone, email, online portal or video. This depends on each doctor office, so check to see if your doctor offers this service.
Independent Health currently covers in-network telehealth/telemedicine services in full with $0 cost-share for services related to COVID-19.
Medicare members are responsible for the cost share associated with ancillary services (e.g. dietitians).
Teladoc® may be available also. Please refer to the question “How am I covered for services related to COVID-19?” (Teladoc is not available to MediSource, MediSource Connect, Essential Plan and Child Health Plus members. Additionally, members who are Self-Funded through your employer should contact us at (716) 631-2661 or 1-800-257-2753 for more information on benefits and the cost.)
We also offer a 24-Hour Medical Help Line, which allows our members to speak with an experienced registered nurse to get answers to questions. The nurses can help members learn more about the treatment and procedure options available for different health problems and diseases. The phone number for the 24-Hour Medical Help Line can be found on the back of your Independent Health member ID card.
Now, more than ever, it is very important to have a primary care physician. A primary care physician (PCP) can properly coordinate your care and serve as the central source for information and guidance on all matters of your health and well-being – even if you’re healthy.
Not sure how to choose the right PCP for you? We can help. Contact Member Services by phone or e-mail.
In the meantime, you may be able to use our telemedicine benefit through Teladoc*, which allows you to talk with a doctor anytime, anywhere by phone, mobile app or online 24 hours a day, 7 days a week.
In addition, we offer a 24-Hour Medical Help Line, which allows our members to speak with an experienced registered nurse to get answers to questions. The nurses can help members learn more about the treatment and procedure options available for different health problems and diseases. The phone number for the 24-Hour Medical Help Line 1-800-501-3439.
If you are thinking of going straight to a facility or hospital for care, we encourage you to call ahead and discuss your concerns with their staff first.
*Teladoc is not available to MediSource, MediSource Connect, Essential Plan and Child Health Plus members. Additionally, members who are Self-Funded through your employer should contact us at (716) 631-2661 or 1-800-257-2753 for more information on benefits and the cost.
Yes, we will provide access to members with pharmacy benefits who need their medications, including medication alternatives and early refills. Members can contact their pharmacy directly for assistance.
Some local pharmacies offer prescription delivery. We encourage you to contact your preferred pharmacy to see if home delivery is available. We currently offer mail-order for maintenance medications through ProAct and Wegmans Mail Order Pharmacy Services.
We are prepared to continue to provide access to members with pharmacy benefits who need their medications, including medication alternatives, in the event of a medication shortage.
If you are experiencing any COVID-19 symptoms, call your primary care physician (PCP). Make sure you tell your PCP if you have been in close contact with a person known to have COVID-19. If you do not have a PCP and are thinking of going straight to a facility or hospital for care, we encourage you to call ahead and discuss your concerns with their staff first.
We understand this is a very difficult and uncertain time for all of us. If you are currently facing financial challenges, we will not terminate your coverage at this time. Contact us to work with you to develop a plan to help you pay your premiums so that your coverage will remain uninterrupted.
Yes, as long as your plan* includes this benefit. At this time, the meal vendor will have the option of providing you with in-home delivery or the frozen meal option only. When the meal vendor contacts you to confirm and schedule your delivery of the meals, they will provide you with the method in which the meals will be delivered. If you select "in-home delivery" but it is not possible, you will be notified that your only option is frozen delivery. Your meals will then be delivered to you together and arrive in one delivery by a postal carrier.
*Benefit included as part of Independent Health’s Medicare Basic and Assure Advantage plans.
No, unfortunately we cannot cover these items for you.
Western New Yorkers who are shopping for a Medicare plan can make an appointment to meet in person with an Independent Health Medicare RedShirt at one of the following Medicare Information Center locations:
- Cheektowaga/Depew: 620 Dick Road
- Orchard Park: 3225 Southwestern Blvd
- Tonawanda: 746 Young Street
- Williamsville: 150 Tech Drive (Independent Health Family Branch YMCA)
- Lakewood: 66 Chautauqua Ave
If you are retiring soon or turning age 65, go to our Find a RedShirt page to learn how you can schedule an appointment to visit one of our Medicare Information Centers. At this time, customer servicing representatives are not present at any of these sites.
Please note: For the safety of our guests and RedShirts, we are requiring everyone to have an appointment in order to visit our Medicare Information Centers, and masks must be worn at all times. No walk-in visits will be allowed. Safety and sanitation protocols, as well as capacity limitations, will be enforced at each site.
All other Independent Health buildings and locations currently remain closed to the public, including our Servicing Center and Medicare Information Center in Lakewood.
If you have questions about your Medicare Advantage plan, our RedShirts are available by phone, Monday through Friday from 8 a.m. to 8 p.m. Please call the number listed on your Member ID card. Or, you may visit our Contact Us page for additional numbers.
If you need to make a payment, you may do so online and choose to set up a monthly payment schedule, or to make a one-time payment.
We know that things are challenging and uncertain with the COVID-19 Coronavirus. Independent Health has identified some resources that may be helpful to you as you navigate this new normal.
Looking for additional information? These local resources may help.
We encourage all members to create their own Independent Health member accounts in order to review their benefits and have access to key details related to their plan.