Your frequently asked questions about COVID-19 (coronavirus)
Have a question about COVID-19? We’re here to help.
COVID-19 vaccine and booster information
What COVID-19 vaccines are available?
COVID-19 vaccines continue to be an important step in reducing risk of severe disease, hospitalization, and death, as well as in slowing the spread of the virus. The Centers for Disease Control and Prevention (CDC) recommends everyone ages 6 months and older get vaccinated to help protect against COVID-19.
Currently, three vaccines are authorized and recommended in the United States to prevent COVID-19. According to the CDC, Pfizer-BioNTech or Moderna mRNA vaccines are preferred for anyone age 6 months and older. Johnson & Johnson’s Janssen COVID-19 vaccine is available in some situations for people 18 years and older.
Does AmeriHealth New Jersey cover the COVID-19 vaccine?
Yes. AmeriHealth New Jersey covers the COVID-19 vaccine as a preventive service.
For individual and group commercial members, there is no cost sharing (co-pays, deductibles, coinsurance) when the vaccine is administered by an in-network health professional. However, if the COVID-19 vaccine is administered by an out-of-network provider, standard cost sharing will be applied based on a member’s health plan benefits.
Are COVID-19 boosters available?
Yes. Boosters are authorized for anyone 6 months and older.
- Updated boosters protect against both the original virus that causes COVID-19 and the Omicron variant BA.4 and BA.5. Two COVID-19 vaccine manufacturers, Pfizer and Moderna, have developed updated COVID-19 boosters.
- Original boosters were designed to protect against the original virus that causes COVID-19. They also provider some protection against Omicron, but not as much as the updated boosters.
The CDC shared guidelines for getting a booster.
Does AmeriHealth New Jersey cover COVID-19 boosters?
Yes. AmeriHealth New Jersey covers the COVID-19 booster as a preventive service.
For individual and group commercial members, there is no cost sharing (co-pays, deductibles, coinsurance) when the booster is administered by an in-network health professional. However, if the COVID-19 booster is administered by an out-of-network provider, standard cost sharing will be applied based on a member’s health plan benefits.
Can I get a COVID-19 booster that’s a different brand than the one I got the first time?
Yes. Some people may prefer the vaccine type that they originally received, and others may prefer to get a different booster. The CDC’s recommendations allow for this type of mix and match dosing for booster shots.
For those who received the Johnson & Johnson’s Janssen shot, there is research that supports following up the initial dose with either Pfizer or Moderna could produce a stronger immunity response than a second dose of the Johnson & Johnson’s Jansen vaccine.
Does AmeriHealth New Jersey provide reimbursement to providers for administering the vaccine and/or boosters?
Yes. AmeriHealth New Jersey takes responsibility as a health plan to bear the costs for the administration of COVID-19 vaccines and boosters for its commercial members.
Does AmeriHealth New Jersey cover diagnostic testing for COVID-19?
Yes. However, starting May 12, 2023, cost-sharing (such as copays, deductibles, and coinsurance) will be applied for medically appropriate, FDA-approved COVID-19 diagnostic and antibody tests ordered by an in-network physician or authorized by a health care professional (unless the member has benefits that include out-of-network coverage). Co-pays, deductibles, and coinsurance are based on the member’s health plan benefits.
AmeriHealth does not cover tests that are needed for return to work, a condition of employment, return to school, or travel.
If you have any questions about whether you should be tested, please contact a health care professional.
Does AmeriHealth New Jersey cover over-the-counter COVID-19 tests?
Yes. However, starting May 12, 2023, AmeriHealth New Jersey will no longer reimburse for over-the-counter/at-home COVID-19 tests. Until May 12, 2023, AmeriHealth New Jersey will continue its coverage of up to eight FDA-approved over-the-counter COVID-19 tests per calendar month as directed by the Biden administration.
Tests that are covered include at-home COVID-19 test kits authorized by the Food and Drug Administration (FDA). The most common tests are BinaxNOW™, Flowflex™, InteliSwab™, On/Go™, and QuickVue®. Covered members can get up to 8 individual tests per month without a prescription (e.g., a family of 4 would be eligible for 32 tests a month).
To receive reimbursement for over-the-counter/at-home tests with a receipt dated May 11, 2023 or prior, members with AmeriHealth New Jersey prescription drug coverage should submit documentation through amerihealthnj.com.
For members with a Health Savings Account or Flexible Spending Account offered through AmeriHEalth New Jersey, receipts can be submitted for reimbursement through those programs at amerihealthnj.com.
Does AmeriHealth New Jersey cover the cost of COVID-19 treatment for its members?
Yes, AmeriHealth New Jersey will continue to cover in-network, inpatient treatment of COVID-19 for commercial members. Standard cost-sharing will apply.
Starting May 12, 2023, AmeriHealth New Jersey will no longer waive cost-sharing for antivirals for the treatment of COVID-19. Co-pays, deductibles, and coinsurance are based on the member’s health plan benefits.
Are telemedicine services for COVID-19 covered?
Yes. However, starting May 12, 2023, standard cost-sharing and co-pays will be applied for all telemedicine visits that individual and group commercial members have with primary care physicians and specialists, including behavioral health providers, regardless of their COVID-19 status. Cost-sharing and co-pays are based on the member’s health plan benefits.
Until May 11, 2023, AmeriHealth New Jersey will cover telemedicine for COVID-19 related services. Please see below for more specific information on how the coverage may apply to you.
Telemedicine services with in-network primary care doctors, specialists, and behavioral health providers are covered until May 11, 2023, for COVID-19 related services. Services must be for testing or to diagnose COVID-19.¹ Normal member cost-sharing applies to telemedicine services that are not related to COVID-19.
Some members can also access MDLIVE for telemedicine visits.² Cost-sharing for those visits vary based on members’ benefits. If you have questions about your access to MDLIVE telemedicine services, please check your member benefits at amerihealthnj.com. To access telemedicine options, log into the member website at amerihealthnj.com.
Does AmeriHealth New Jersey cover telemedicine services for members that don’t have a COVID-19 diagnosis?
Yes. AmeriHealth New Jersey has a permanent telemedicine policy for fully insured and self-funded commercial members. The policy covers many of the expanded telemedicine services made available during COVID-19 and includes substantially more telemedicine services than the policy that was in place before the pandemic.
Please note that there are some services better performed face-to-face that we covered through telemedicine at the height of the pandemic to keep everyone safe and health that are no longer covered through telemedicine under the permanent policy. To see all the telemedicine services covered by AmeriHealth New Jersey, visit the medical policy page.
Does AmeriHealth New Jersey cover telemedicine services from non-participating providers for members with out-of-network coverage?
Given AmeriHealth New Jersey’s broad network, it is unlikely that a member would need to seek care from an out-of-network provider. Telemedicine visits from out-of-network providers are covered for commercial members with out-of-network coverage and are subject to the out-of-network cost-sharing under the member’s benefit plan. This applies to specialists, including behavioral health providers.
If someone wants more information about COVID-19, where should they go?
If you are looking for more information about specific symptoms you are experiencing or have questions about your personal health, we recommend you contact your doctor. For reliable information about COVID-19, we suggest visiting the Centers for Disease Control and Prevention (CDC) website at cdc.gov/coronavirus. The State of New Jersey has also established a website with information about COVID-19.
Our comprehensive website dedicated to COVID-19 also has information and resources available. We continue to update our newsroom and social media channels with the latest information about COVID-19.
How can members protect themselves against fraud?
Unfortunately, fraud exists everywhere. AmeriHealth New Jersey, like many other organizations, have received some reports of potential frauds and scams related to COVID-19.
Members should be aware of individuals attempting to profit from this emergency and should remain diligent in protecting personal and health insurance information. Some of the reports we have received include:
- Individuals and businesses selling fake tests, treatments, and cures for COVID-19 online
- Phishing emails from entities posing as trusted organizations like the World Health Organization or the Centers for Disease Control and Prevention
- Online sellers falsely claiming to have in-demand products like cleaning, household, and health and medical supplies
- Unsolicited calls, e-mails, or home visits from individuals offering free services or supplies in exchange for member numbers
Members can help to avoid fraud by following these tips:
- Reviewing medical claims submitted at AmeriHealth New Jersey for accuracy
- Protecting their insurance card
- Protecting their identity and not providing their Social Security Number
- Declining to provide insurance information to anyone that is not directly providing care to a member
- Being cautious of unsolicited telemarketers and recruiters
If members suspect that something potentially fraudulent has occurred with respect to their AmeriHealth New Jersey health insurance, they should contact us. All reports can be submitted anonymously. Here are three options for submitting a report:
- Submit through the Online Fraud & Abuse Tip Referral Form
- Call our confidential Fraud Hotline at 1-866-282-2707 (TTY: 888-789-0429). 24 hours a day, 7 days a week
- Mail a description of your complaint, enclose copies of any supporting documentation, and mail it to:
AmeriHealth New Jersey
Corporate & Financial Investigations Department
1901 Market Street, 42nd Floor
Philadelphia, PA 19103
¹The Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act mandate that member cost-sharing (co-pays, deductibles, and coinsurance) is waived both in and out-of-network for the testing and diagnosis of COVID-19 through the public health emergency. The waiver of member cost sharing for both in and out-of-network will continue through the public emergency.
²If a member has coverage through an employer, benefits and coverages may vary. MDLIVE is an independent company.