Health Topics & Information

Coronavirus (COVID-19)

MetroPlusHealth wants YOU to stay healthy this fall and winter.

Vaccinations against COVID and flu are among the best tools for health and wellness during the cooler months. They protect you, your colleagues and loved ones now…and leading up to the end-of-year holidays.

What’s new?

  • Brand new COVID boosters are now available; in studies, they showed an improved response to the newest COVID strains (“omicron”) compared with the original vaccine.

  • Anyone who completed their primary COVID vaccination “series” (1st and 2nd doses to Pfizer or Moderna, 1 dose of Johnson & Johnson) and regardless of any past boosters. You just need to wait 2 months since your last vaccine or 3 months since any recent COVID infections.

  • Experts encourage adults to receive their brand new COVID booster and their influenza vaccine at the same time, one shot in each arm, two for one.

Why should I get vaccinated and/or a booster shot? When can I get COVID-19 vaccines or booster shot? What is the risk of getting a booster shot?

The CDC states that after getting vaccinated against COVID-19, protection against the virus and the ability to prevent infection from variants may decrease over time. The recent arrival of the Omicron variant further intensifies the importance of vaccination, boosters, and prevention efforts needed to protect against COVID-19.

  • Everyone 5 years of age and older is now eligible to get a COVID-19 vaccination.
  • Everyone ages 18 and older should get a booster shot.

Adults and children may have some side effects from a COVID-19 vaccine, including pain, redness or swelling at the injection site, tiredness, headache, muscle pain, chills, fever, and nausea. Serious side effects are rare but may occur [7].

Maximize your protection against COVID-19. Free booster shots are available statewide. To learn more about booster shots go to Booster Doses COVID-19 Vaccine (ny.gov)

A second booster shot is also now available. Click on the following link to see if you are eligible for a second booster shot COVID-19: Vaccine – NYC Health

How much will I pay for the COVID-19 vaccines or booster shots?

MetroPlusHealth will cover COVID-19 vaccines and booster shots at no cost to all members.

Will I have a reaction after I receive my vaccine or booster shot?

So far, reactions reported after getting the vaccine or booster shot might be fever, headache, fatigue, and soreness at the injection site.

Note that people are considered fully vaccinated 2 weeks after their second dose in a 2-dose series, (like the Pfizer or Moderna vaccines) or 2 weeks after a single-dose vaccine, like Johnson & Johnson’s vaccine.

What You Need to Know About COVID-19

COVID-19 changed life around us and has had a tremendous impact here in New York City. We know that you have questions about the virus and its variants (Delta, Omicron) and how it can affect you and your family. You may also want to know more about the vaccines and/or booster shots and what you can do to stay healthy and safe. We’re here to help.

What to do if you think you have COVID-19

If you have symptoms such as fever, cough, shortness of breath, sore throat, chills, repeated shaking with chills, muscle pain, or new loss of taste or smell, you should act as if you have COVID. Talk to your doctor to find out what he/she recommends. Remember, unless you have life-threatening circumstances such as difficulty breathing that require calling 911 or going to an emergency department, stay home and call your doctor’s office to discuss your symptoms before going to a healthcare facility, ER or testing site. This helps prevent the spread of the virus.

If you need additional information regarding COVID-19, you can call your doctor or the NYC Health and Hospital Hotline at 844-692-4692.

If you are sick with any of the symptoms above, you must stay inside and quarantine yourself from others. This means you do not go to work, school, or ride public transit. Ask someone else to buy groceries for you or order delivery of food/groceries. For more information about food access, visit https://www1.nyc.gov/site/hra/help/food-assistance.page

While at home, stay as far away from the people you live with as is possible. Do not share personal items, like dishes, towels, or bedding, with others. Cover your mouth and nose when around others by wearing a mask. Wash your hands frequently and clean all surfaces you touch with household cleaning spray. To learn how to select, properly wear, clean and store masks click here:  Your Guide to Masks | CDC

Newer Variants and How to Protect Yourself

Some of the newer COVID-19 variants spreads more easily than the original virus that causes COVID-19. Here are 3 things you can do to help protect yourself and others:

  1. Get vaccinated! Vaccines are the best tool to protect everyone from COVID-19.  Vaccines slow the transmission of the virus and provide strong protection against severe illness and hospitalization.
  2. Get the booster when you’re fully eligible. Everyone 18 years and older should get a booster shot 2 months after their Johnson & Johnson vaccine, or 5 months after completing their primary COVID-19 vaccination series of Pfizer or Moderna. Adolescents and teens ages 12 to 17 should also get a booster of Pfizer 5 months after their first two shots.
  3. Continue wearing a mask in indoor public places in areas of high or substantial community transmission. Click here to see the COVID-19 County Check Tool to find your county’s level of community transmission.

To learn more about the Omicron variant click here Omicron Variant: What You Need to Know | CDC

To find vaccines and booster shots visit Vaccines.gov – Find COVID-19 vaccine locations near you
 

COVID-19 Symptoms

COVID-19 symptoms can appear 2 to 14 days after a person has contact with the virus. Symptoms include:

  • Fever
  • Fatigue
  • Headache
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting, and diarrhea
  • Cough
  • Trouble breathing or shortness of breath
  • Chills
  • Repeated shaking with chills
  • Muscle pain
  • New loss of taste or smell

Most people who have COVID-19 will have mild symptoms, but certain other health conditions can put people at higher risk of severe illness, including chronic lung disease, heart disease, diabetes, and cancer. Older adults are also at a higher risk.
 

How can I safely see a doctor for normal health concerns (flu, pink eye, urinary infection, therapy)?

Many participating MetroPlusHealth providers are now offering telehealth visits. Check with yours to see if this is an option that will work for you. If you need to see a doctor right away, you can see one safely without leaving your home!

PLEASE NOTE: Starting January 31, 2022, MetroPlusHealth members can access free 24/7 telehealth services by visiting ExpressCare By NYC Health + Hospitals – Video or In-Person Doctor Appointments or by calling 800-303-9626 (TTY: 711) for more information.
 

How does COVID-19 spread?

It spreads among people who are in close contact with an infected person, primarily through very small amounts of virus in droplets sprayed from the nose and mouth. An infected person’s breath, talk, laugh, singing or coughing/sneezing can infect a healthy individual. Wearing a mask, avoiding crowed places, washing hands, or using hand sanitizers and keeping your distance will help prevent the spread of the virus.
 

Who is at risk for COVID-19?

Older adults and those with weakened immune systems, chronic lung disease, heart disease, diabetes, and cancer are at highest risk.  If you are in any of these categories, we strongly encourage you to get vaccinated and when eligible receive a booster shot.  For information about vaccine shots near you visit Vaccines.gov – Find COVID-19 vaccine locations near you

All persons can reduce the risk to themselves and others by wearing a mask, practicing physical distancing, washing their hands often, and taking other prevention measures.
 

What should people do to stay safe?

Authorized COVID-19 vaccines are now available for free to help stop the spread of COVID-19. Children and adolescents 5 years and older are eligible for the COVID-19 vaccine and should be vaccinated. Click here for more information and to find a provider.
Vaccination helps protect people by reducing the chance of getting COVID-19 and lowering the chance of getting seriously ill even if they do get COVID-19. Other ways to help stop the spread of COVID is to continue practicing social distancing, wearing a mask and proper hand washing. Make sure to wash your hands with soap and water for at least 20 seconds. You can use hand sanitizer if soap and water is not available but wash your hands as soon as possible.

You should also avoid touching your face (especially your eyes, nose, and mouth) with unwashed hands. If you need to cough or sneeze, cover it with a tissue and then throw the tissue out.
 

Can I get the flu vaccine AND the COVID-19 vaccine at the same time?[3]

Yes!  People can get a COVID-19 vaccine and other vaccines, including the flu vaccine, at the same time.
Call your provider if you have further questions or concerns.
 

Who should get tested for COVID-19?

COVID-19 testing is widely available. MetroPlusHealth covers the cost of COVID-19 testing at no cost share for members. The following people are highest priority for COVID-19 testing:

  • Anyone with symptoms.
  • Anyone who had close contact within the previous 5 days with a person who was confirmed to have COVID-19, especially household contacts, and intimate partners (assuming they have not been vaccinated)[4].
  • Anyone who works in a group residential setting, such as a nursing home, adult care facility, and homeless shelter.
  • Before and after attending a get-together (especially if they or any attendee is not fully vaccinated or is at risk of severe COVID-19)
  • Three to 5 days after traveling[5]

You can get a test at many providers’ offices, clinics and pharmacies. You can also test at home. You can click here to find a community testing site near you.
 

Why should my 5-year-old get vaccinated?

People of all ages can get COVID-19. With more contagious variants of the virus, younger people are getting COVID-19 and being hospitalized. Also, getting children vaccinated helps protect others, such as grandparents and relatives who have a medical condition that increases their risk for severe COVID-19. It even helps people in your area, since being vaccinated helps stop the spread of the virus.
 

I am currently ill with symptoms consistent with COVID-19. Should I be tested?

At this time, anyone with COVID-19 symptoms should be tested by receiving a swab or saliva test. Call your doctor if you think you might need to be tested. You can also find a community testing site near you here.

If you have mild to moderate symptoms, stay home while you wait to be tested. Do not leave home except to get essential medical care (including testing for COVID-19) or to get basic needs such as groceries (if someone can’t get them for you). If you have more serious symptoms, please seek medical care right away. You can also call NYC Health and Hospital Hotline at 844-692-4692 for COVID-19 related medical advice.
 

What is the treatment for COVID-19?

Treatment is available and consists of a mix of approaches, including medicine, infection prevention and control measures, and supportive care, like supplemental oxygen and support for ventilation. Treatment depends on the individual’s illness. Many people will need no treatment at all if they have mild illness, or will need only pain and fever-reducing medications like acetaminophen and ibuprofen.

People with serious cases might need to stay in the hospital to be monitored while they are sick. Doctors can make sure that patients can stay hydrated and are breathing properly.
 

Will I be able to get COVID-19 vaccines?

Safe and effective COVID-19 vaccines are now available in New York City to help us end the COVID-19 pandemic. They are free and easily available without appointment.

Children and adolescents 5 years old and older are eligible for the COVID-19 vaccine. Click here for more information and to find a provider. – https://covid19vaccine.health.ny.gov/covid-19-vaccines-children-and-adolescents
 

Why should I get vaccinated and/or a booster shot? When can I get COVID-19 vaccines or booster shot? What is the risk of getting a booster shot?

The CDC states that after getting vaccinated against COVID-19, protection against the virus and the ability to prevent infection from variants may decrease over time. The recent arrival of the Omicron variant further intensifies the importance of vaccinationboosters, and prevention efforts needed to protect against COVID-19.

  • Everyone 5 years of age and older is now eligible to get a COVID-19 vaccination.
  • Everyone ages 18 and older should get a booster shot.

Adults and children may have some side effects from a COVID-19 vaccine, including pain, redness or swelling at the injection site, tiredness, headache, muscle pain, chills, fever, and nausea. Serious side effects are rare but may occur [7]

Maximize your protection against COVID-19. Free booster shots are available statewide. To learn more about booster shots go to Booster Doses | COVID-19 Vaccine (ny.gov)

A second booster shot is also now available. Click on the following link to see if you are eligible for a second booster shot COVID-19: Vaccine – NYC Health
 

How much will I pay for the COVID-19 vaccines or booster shots?

MetroPlusHealth will cover COVID-19 vaccines and booster shots at no cost to all members.
 

Will I have a reaction after I receive my vaccine or booster shot?

So far, reactions reported after getting the vaccine or booster shot might be fever, headache, fatigue, and soreness at the injection site.

Note that people are considered fully vaccinated 2 weeks after their second dose in a 2-dose series, (like the Pfizer or Moderna vaccines) or 2 weeks after a single-dose vaccine, like Johnson & Johnson’s  vaccine.
 

Once I am vaccinated, what can I do during my daily life?

All activities are safer once someone is fully vaccinated! A good practice is to continue to take precautions in public places, like wearing a mask, staying 6 feet apart from others, and avoiding crowds and poorly ventilated spaces.
 

Will the At-Home (Over-the-Counter) Test Kits be covered?

Yes, beginning 1/19/2022 anyone can order free tests directly from the US Government.  Visit covidtests.gov for more information.

Additionally, MetroPlus Managed Medicaid, Partnership in Care (PIC), and Enhanced (HARP) Plan members can receive 2 (two) tests or 1 (one) test kit per week covered at no cost from any in-network pharmacy without a prescription.

For Essential Plan and Child Health Plus Plan members, 2 (two) test kits per week are covered at no cost from any in-network pharmacy without a prescription.

For Market Place and Gold/GoldCare Plan members, 2 (two) tests or 1 (one) test kit per week is covered at no cost from any in-network pharmacy without a prescription. These members may purchase kits from out-of-network pharmacies and submit for reimbursement for a maximum of $12 (twelve) dollars per test. The 2 (two) test maximum applies whether the tests are purchased in or out of network. Members can visit Caremark.com or the CVS Caremark mobile app (available for Android and Apple) to submit online for reimbursement. Members can also submit a paper claim form to CVS Caremark for reimbursement. More information below.
 

Which At-Home (Over-the-Counter) Test Kits are covered?

BinaxNow (NDC: 11877001140), QuickVue (NDC: 14613033972), IntelliSwab (NDC: 08337000158), Carestart (NDC: 50010022431), IHealth COVID-19 AG Rapid Test (NDC: 56362-0005-89), Flowflex Kit Home Test (NDC: 82607-0660-26, 82607-0660-27), more kits may be added for coverage.
 

Do I need to wear a mask?

Yes, as of December 13, 2021, the Commissioner of the NYS Department of Health ordered the wearing of the face masks in all indoor public areas that do not require proof of vaccination as a condition of entry to avoid spreading the virus[8].
 

How can I get my prescriptions?

Our members can go to any CVS Caremark in-network pharmacy to fill prescriptions. The MetroPlus PillPack program allows members to get multiple medications pre-packaged and sent to your home for no additional cost. To sign up, you can contact PillPack directly at 855-745-5725.
 

How can I get a 90-day supply of my medicine?

You can fill a 90-day supply of your approved maintenance medications at any in-network pharmacy of your choice. You can also get them mailed right to your home if your pharmacy offers delivery service or through one of our mail-order pharmacy partners such as CVS. For more information or assistance in setting up home delivery service, please contact the MetroPlus Health Plan Customer Service number on your member ID card or your local pharmacy.
 

What if I need an emergency supply of medication?

During this public health crisis, MetroPlusHealth Medicare members will be allowed a short-term supply for most essential medications even if you are not due for a refill at any in-network pharmacy.
 

Can I have my medicine delivered to my door on the same day?

MetroPlusHealth has network pharmacies that offer free delivery. Such as Medly Pharmacy, you can visit: https://medly.com/en-us/partner/metroplus or call phone number: (929) 454-5090 to sign up.

To find a pharmacy near you, click here.
 

What if I have other questions about my pharmacy benefits?

Call the MetroPlus Health Plan Customer Service number on your member ID card to speak to a representative who will help you get the services you need.
 

Will MetroPlusHealth cover the new medications approved to treat COVID-19?

The FDA has issued an Emergency Use Authorization (EUA) for both Plaxovid (nirmatrelvir and ritonavir) and Lagevrio (molnupiravir), which are oral antiviral medications for the treatment of COVID-19, when indicated by a physician. All Plan members can receive these medications from their in-network pharmacy.

The monoclonal antibody EVUSHELD (tixagevimab co-packaged with cilgavimabis) is also available, when indicated by a physician for MetroPlus Managed Medicaid, Partnership in Care (PIC), Enhanced (HARP) and Child Health Plus Plan members when administered at an in-network pharmacy. EVUSHELD is available to all Plan members when administered at an in-network outpatient facility.
 

Where can I find more information about COVID-19?

Please use the following resources to keep yourself informed:

The Official Website of the City of New York
https://www1.nyc.gov/site/doh/covid/covid-19-main.page

The New York Department of Health
https://coronavirus.health.ny.gov/home

https://www.health.ny.gov/health_care/medicaid/fact_sheets/docs/covid/english.pdf

The New York Department Hotline – 1-888-364-3065

NY Project Hope – Coping with COVID
https://nyprojecthope.org/

Centers for Disease Control and Prevention (CDC)
https://www.cdc.gov/coronavirus/2019-nCoV/index.html

Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/covid-19-cold-flu-and-allergies-differences/art-20503981

Helpful Resources

Covid Test Paper Claim Form
Reimbursement Flyer
last updated: October 27, 2022

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