Members | Medicare FAQ

We know this is a challenging time. As the situation around COVID-19 changes, PacificSource aims to keep you informed about how to take care of yourself and your loved ones, and how we’re supporting your health and safety.

COVID-19 Benefit Updates

Yes. Members pay $0 for COVID-19 testing and diagnosis. Most COVID-19 treatments in a doctor’s office, urgent care, or emergency room setting may also have out-of-pocket costs waived.

If you’re diagnosed with COVID-19, additional services including hospitalization will be covered according to your plan benefits.

If you’re receiving care from an out-of-network provider, you may be responsible for the balance that exceeds the maximum allowable for the service provided. Out-of-network care can include office visits, urgent care, and emergency-room treatment.

COVID-19 Vaccine Information

Yes, the cost of administering the vaccine will be covered in full at both in-network and out-of-network providers.

The roll-out of the vaccine will continue through 2021; each state sets its priorities for distribution. For more information, see the state specific information below:

How, Where, and When to Seek Care

For any upcoming medical, dental or behavioral health appointments, call your provider’s office (assuming you haven’t already heard from them). Because of the current crisis, many routine, preventive care, elective procedures, and surgeries are likely to be postponed.

If you have flu-like symptoms, you should assume you have a virus and take precautions. Call your doctor’s office for guidance.

If you or a loved one has an ongoing health problem, call your doctor’s office first. If you’re not feeling well or have physical or mental health concerns, take these steps:

  • Call your primary care provider first before going in.
  • Call our 24-Hour NurseLine at (855) 834-6150, TTY (844) 514-3774
  • Check with your doctor to see if telehealth services are available

Telehealth is an appointment with a doctor by phone or video. Telehealth visits for COVID-19 testing and testing related services will be covered at no cost. All other health care needs using telehealth will be paid at your normal benefit level.

  • Medical visits
  • Behavioral health (including therapy and substance abuse)
  • Speech therapy
  • Occupational and physical therapy

Filing Prescriptions

You can receive a one-time early refill for prescription drugs.

You can also have your regular medications sent to you free. To get started, register online or call CVS Caremark Mail-Order Services:

  • Register online at CareMark.com
  • Toll-free: (866) 362-4009
  • TTY/TDD: 711

Staying Safe

Yes, but stay informed about how to protect yourself and prevent spreading the virus. When leaving home, for instance, it’s best to remain in your local community, avoid confined indoor spaces, wear face coverings, and keep a distance of at least six feet apart from others. Keep in mind that where you live may determine the types of businesses that are open. Each state has its own set of local guidelines:

According the Centers for Disease Control and Prevention (CDC), the following symptoms should prompt you to seek emergency treatment.

  • A fever of 104F or higher
  • Difficulty breathing
  • Persistent pain or pressure in the chest
  • Confusion or inability to arouse
  • Bluish lips or face
  • Any other symptom that is severe or concerning

Because older people are advised to stay home, here are things you can do to support those who are older:

  • Deliver groceries or prescriptions to their homes
  • Call them to talk
  • Try a video chat (such as Skype, FaceTime, and Google Hangouts) so you can see each other
  • Write emails or send photos, books or puzzles
  • Encourage them to wash their hands often

If you’re feeling the emotional and mental weight of this moment, you’re not alone. It’s natural to feel stress and anxiety right now, whether you’re wondering what to do if you feel sick or you’re stressed about how to get and pay for care. No matter what, your options to support your total health should always include talking with a medical health professional. With expanded telehealth services, you’re able to meet with a behavioral health professional from home.

To learn more, see the COVID-19-related Health and Wellness information here.

More Information You Can Download

COVID-19 Coverage Overview – English

PacificSource Customer Service

The PacificSource Customer Service team remains available during business hours, Monday through Friday, from 8:00 a.m. to 8:00 p.m. As long as COVID-19 is a concern, PacificSource remains focused on how best to serve you. We’ve taken significant steps to remain fully operational to provide our usual high level of service throughout the duration of the crisis.

We want to help. If you have any questions, we welcome your call.

PacificSource Community Health Plans is an HMO/PPO plan with a Medicare contract. Enrollment in PacificSource Medicare depends on contract renewal.