Your guide to COVID-19

The COVID-19 vaccine, tests, and treatment are covered differently based on your plan’s benefits:

COVID-19 vaccine: It’s covered at no-cost.

Self-tests (or home antigen tests): If you’re a Medicaid beneficiary, these tests are covered at no cost. For most other plan members, these tests are not covered. 

COVID-19 PCR test: If you’re a Medicaid patient, PCR tests are covered at no cost. For all other plan members, you’ll pay some costs, depending on your plan.

COVID-19 treatment: If you’re a Medicaid patient, treatment is covered at no cost. For all other plan members, you’ll pay some costs, depending on your plan.

Out-of-network COVID-19 services: If you’re a Medicaid patient, out-of-network COVID-19 care is covered at no cost. For all other plan members, the vaccine, tests, and treatment received outside of Kaiser Permanente are covered only if part of urgent or emergency care, if legally required, or if your plan includes out-of-network coverage.

Sign in to your account to see your Evidence of Coverage or other plan documents for details about your coverage.

People with COVID-19 may have mild to severe symptoms, including fever, cough, and difficulty breathing. Other symptoms may include chills, muscle pain, headache, sore throat, and loss of smell or taste. While patient information shows most cases are mild, symptoms tend to be more severe in older adults and people with chronic conditions.

The Centers for Disease Control and Prevention (CDC) recommends everyone ages 6 months and older receive a 2024-2025 COVID-19 vaccine to protect against potentially serious illness this fall and winter. 

It’s especially important to get vaccinated if you’re at high risk for complications from COVID-19. Older people and those with weakened immune systems have a greater risk for hospitalization and even death from the virus. However, even healthy children and adults can get seriously ill from COVID-19.

Learn more about the vaccine.

Paxlovid is a treatment for people who have an active COVID-19 infection and are at high risk for serious illness. It’s available by prescription at Kaiser Permanente pharmacies. Your care team may recommend it if:

• You’re 12 or older
• You’ve recently tested positive for COVID-19
• Your symptoms started within the last 5 days
• You have health conditions that put you at high risk for serious illness from COVID-19

For some people, Paxlovid may have 2 mild side effects: a metallic taste in the mouth and diarrhea. These side effects will go away once you’ve finished taking Paxlovid. Also, your care team will check what medications you’re taking and determine if any of them need to be held or have dosing changed while you are taking Paxlovid. 

If you are a Kaiser Permanente Medicare Advantage member who resides in Maryland or Virginia, and you are unable to obtain services from Kaiser Permanente providers during this state of emergency, you may access covered services from out-of-network providers.

In Maryland, this flexibility applies from when the Governor of Maryland declared a state of emergency on January 4, 2022 and until the state of emergency ends on February 2, 2022.In Virginia, this flexibility applies from when the Governor of Virginia declared a state of emergency on January 10, 2022 and until the state of emergency ends on February 11, 2022.

Please call Medicare Member Service Contact Center at Medicare Member Service Contact Center at 1-888-777-5536 (TTY 711), seven days a week, 8 a.m. to 8 p.m. ET, for assistance in accessing care and covered services. Language interpretation services can be accessed via the same number.

When calling, be sure to notify the member services representative that you reside in Virginia and are impacted by the state of emergency. If you access services from an out-of-network provider during this emergency and receive a bill, you should submit the invoice to Kaiser Permanente for payment/reimbursement as appropriate.

If you access services from an out-of-network provider during this emergency and receive a bill, you should submit the invoice to Kaiser Permanente for payment/reimbursement as appropriate.