I have Florida Blue Medicare. What changes will I see now that the public health emergency has ended?

Now that the COVID-19 public health emergency is over, here are the key things you’ll notice:

1. Your cost share may change.

The federal government allowed health plans like Florida Blue Medicare to lower the cost share for certain services during the pandemic. Now that the public health emergency has ended, your normal cost share will apply. This applies to:

• COVID-19 testing and related services
• Behavioral health office visits and outpatient services

Note: Dual Eligible Special Needs (DSNP) plan members still have a $0 cost share.

If you have questions about your health plan benefits, call the number on your member ID card.

2. You’ll still be able to see your provider virtually.

Many people have enjoyed the convenience of a virtual visit (telehealth), which became more common during the pandemic. Your virtual visit benefits are now standard on your plan. Now that the public health emergency has ended, you will pay your normal cost share (what you pay out of pocket) for the following services:

3. Vaccines are at $0 cost to you.

Vaccines, including the COVID-19 vaccine and booster, are at no extra cost because they are part of your wellness benefits. We encourage our members to stay up to date on all their vaccines.

4. HMO members will need to see in-network providers for their care to be covered under their HMO benefits. PPO members will have a lower cost share getting care from an in-network provider.

Florida Blue Medicare HMO members are required to see providers in their HMO network to have their health care services covered. If they don’t, they may have to pay for the entire cost of their care, unless it’s an emergency. During the pandemic, we wanted to make it easier for all members to get health care. HMO members were able to see providers not in the HMO network. Now that the public health emergency has ended, if you see a provider who is not in your health plan network, your health care may not be covered. This includes anyone you see for health care services and every location you go to for services, including doctors, specialists, hospitals, labs, imaging sites, etc. (X-rays, MRIs, etc.). Florida Blue Medicare PPO members can continue seeing providers not in the PPO network, but they’ll pay the higher out-of-network cost share (amount the member pays).

We’re here to help you find a provider who is in your network and near you. You can find a list of local primary care doctors by:

• Visiting FloridaBlue.com/Medicare to check our searchable provider directory.
• Calling us at 1-800-926-6565 (TTY: 1-800-955-8770). The hours are 8 a.m. to 8 p.m. ET, seven days a week from October 1 through March 31, (except Thanksgiving and Christmas). From April 1 through September 30, we are open Monday through Friday, 8 a.m. to 8 p.m. ET.
• Visiting one of our Florida Blue Centers for face-to-face assistance. You can find a local Florida Blue Center at floridablue.com/center or by calling 1-877-352-5830.

Please remember: For emergency care, you will always have coverage, regardless of whether the provider is in your network.

I’m under 65 years old, what does the end of the public health emergency mean for my coverage?

Don’t worry, the end of the public health emergency doesn’t impact whether you still have coverage. You do! But some things may have changed if you have coverage through your job or you buy it on your own (not Medicare). As an extra service during the COVID-19 pandemic, members enrolled in our HMO plans through their employer health plan, or plans they purchased themselves, were able to see providers who were not in the Florida Blue HMO networks for care related to COVID-19.

For Florida Blue HMO members, your standard benefits and provider networks have returned to in-network only. This means that for HMO members to have their health care services covered, they must see providers in their HMO network. This includes doctors, hospitals, imaging centers, and more. Note: If you’re a Florida Blue Medicare HMO member, please see the section above regarding your Medicare benefits.

If you have a Florida Blue PPO plan, you may continue to see out-of-network providers, however, your cost share may be higher. You will no longer be charged the in-network cost share for seeing out-of-network providers. This means your out-of-pocket costs will likely increase if you continue to see out-of-network providers.

Please don’t worry! We have a large network of high-quality doctors and other health care providers in the Florida Blue networks who are near you.

• For HMO members, your selected or assigned primary care doctor will coordinate all your care and get you a referral to a specialist when needed. Your primary care doctor is listed in your member account.
• For PPO members, you can find a list of local in-network providers, including primary care doctors, specialists, urgent care centers, and more, by:
  • Visiting floridablue.com to check our searchable provider directory.
  • Calling us at 1-800-FLA-BLUE (352-2583) TTY/TDD: 1-800-955-8770.
  • Visiting one of our Florida Blue Centers for face-to-face personalized support. You can find a local Center at floridablue.com/center or by calling 1-877-352-5830.

What about COVID-19 testing, treatment, and vaccines? 

During the COVID-19 public health emergency, the government worked with health plans and providers to make available no-cost COVID-19 testing, treatment, and vaccines. This was to make sure you had immediate access to care during the height of the pandemic.

Now that the public health emergency has ended, some of these government-funded services have also ended. As a Florida Blue member, some of these services will continue to be covered under your health plan. Here’s what you need to know:

• Testing and treatment: Testing and/or treatment for COVID-19 is now covered under your health plan benefits, just like any other covered health condition or test. You can get the care you need when you need it. Your normal member cost share will apply.
  • Where to get a COVID-19 test? If you’re concerned that you may have COVID-19, there are several options to consider for getting tested:
    • Florida COVID-19 Testing Sites
    • Your primary care doctor (they can help direct you to a testing site if unable to provide a test)
    • Local pharmacies
    • Urgent care centers 
    • GuideWell Emergency Doctors, an in-network provider under many Florida Blue plans, with locations in Greater Orlando (Winter Park, Orlando, Ocoee and Kissimmee) and Tampa Bay (West Tampa, University Area, North Tampa, Palm Harbor, Largo, and St. Petersburg)
• When should I get tested for COVID-19? Testing is most important for those who are older and/or have certain medical conditions, like diabetes, since it can put them at increased risk for severe illness from COVID-19. If you have been exposed to COVID-19 and have symptoms, check the latest CDC testing recommendations for more details.
• Vaccines: Vaccines, including the COVID-19 vaccine and booster, are now part of your wellness benefits and provided at no-extra-cost for most members.¹
• At-home/OTC tests: Like other at-home tests or pharmacy over-the-counter (OTC) items, COVID-19 at-home tests will not be covered under your health plan. You may be able to use your flexible spending account or health savings account to pay for these items.

If you have questions about your health plan benefits, call the number on your member ID card.

Do I still have access to virtual care visits?

Many people enjoy the convenience of a virtual health care visit, which became more common during the pandemic. As a result, virtual care visits are now a standard benefit for Florida Blue members with individual plans, Medicare Advantage plans, and most employer health plans.² This includes primary care visits with your doctor, mental health counseling, and urgent care visits through your doctor’s office or Teladoc, our virtual care partner.

If you have questions about your health plan benefits, call the number on your member ID card.

Going forward, how can I continue to protect myself from COVID-19?

The best way to protect yourself from getting seriously ill from COVID-19 is to be up to date on your COVID-19 vaccine and booster. Here are some important things to remember:

• Vaccines and boosters are available for everyone ages 6 months and up.
• You’re considered up to date on your COVID-19 vaccines when you have completed a COVID-19 vaccine primary series and received the most recent booster dose recommended for you by the Centers for Disease Control and Prevention (CDC).
• If you’ve completed your primary series, but are not yet eligible for a booster, you’re also considered up to date. Click here to learn more about the vaccines.
• If you become ill with COVID-19 after receiving all COVID-19 vaccine doses recommended for you, you’re also considered up to date. You do not need to be revaccinated or receive an additional booster.

And remember, vaccines and boosters are part of your preventive benefits, which means there’s no extra cost to you. You also may be able to earn rewards if you get your annual COVID-19 booster! Check your member account to learn more.

If you have questions about COVID-19 or vaccines, we’re here to help. Talk with a Florida Blue Center nurse at 1-877-352-5830 for one-on-one, personalized support and answers to your questions. We’re here for you Monday through Friday, 9 a.m. to 7 p.m., and Saturday, 9 a.m. to 4 p.m. even if you’re not a Florida Blue member.

My doctor said I’m at a higher risk for getting very sick from COVID-19. Is it still as serious as it was during the pandemic?

COVID-19 is still a serious disease caused by SARS-CoV-2. If you have certain underlying medical conditions, you’re more likely to get very sick from COVID-19 and are at a greater risk for being hospitalized, needing intensive care, requiring a ventilator to assist with breathing, or even losing your life. Click here to learn more about what medical conditions are considered high risk for COVID-19 and require extra precautions.

My doctor says I have Long COVID. Where can I find more information on this?

Long COVID or Post-COVID Conditions develop when you experience long-term effects from COVID-19. Symptoms and health-related problems can be wide-ranging and can be different for everyone. Once you develop symptoms, they can last for weeks, months, or years after infection. You can learn more about Long COVID and Post-COVID Conditions by visiting the CDC.

¹Some grandfathered plans may have a cost share for preventive benefits. Please check your plan benefits.

²Florida Blue will continue to work closely with its self-funded ASO group employers to assist them in meeting the needs of their employees and address any benefit changes.