Rochester, NY

Monkeypox Q&A

With the United States experiencing an outbreak of the monkeypox virus, Kathleen Robischon, MD, answers some common questions about the disease.   

Dr. Robischon is a senior medical director at Excellus BlueCross BlueShield.

Please note: Consult your doctor if you believe you’re at risk for monkeypox or have questions about the virus. Your doctor knows you best and will help you determine next steps.
    

Q. What is monkeypox?
Monkeypox is a rare disease that can cause a variety of symptoms, including a rash that can be painful and look like pimples or blisters. For more on monkeypox symptoms: Centers for Disease Control and Prevention.


Q. Will I become seriously ill if I get monkeypox?
The virus typically does not cause serious illness and it’s rarely fatal.
Certain groups, however, are at risk of serious illness should they contract the disease. You’re at risk of serious illness if you’re under the age of eight, have a weakened immune system, or are pregnant, breastfeeding or have a history of eczema.


Q. How does monkeypox spread?
Monkeypox mostly spreads through close, physical contact. You’re at greater risk of getting the virus if you: 

  • Touch the rash or scabs of a person who has monkeypox.   
  • Kiss, hug, or have sex with someone who has monkeypox. 
  • Touch the clothing, bedding, towels or other items that were used by an individual with monkeypox.

For more on preventing monkeypox: Centers for Disease Control and Prevention 


Q. Where do I go for the latest information?
Please visit the following sites for the latest information on monkeypox:   
•    Centers for Disease Control and Prevention 
•    New York State Department of Health 
If you believe you’ve been exposed to monkeypox and/or experience symptoms, please contact your doctor.


Q. Is there a Monkeypox vaccine?
The U.S. Food and Drug Administration has approved vaccines for monkeypox.  New York Governor Kathy Hochul also issued an Executive Order on July 29, 2022, declaring a State Disaster Emergency in response to the ongoing monkeypox outbreak. The executive order extended the pool of eligible individuals who can administer monkeypox vaccines. 


Q. Who is eligible for a monkeypox vaccine?
Individuals may be eligible for the vaccine if they’ve recently been exposed to monkeypox or are at high risk for exposure. Here is more on current vaccine eligibility in New York state


Q. Where can I get a monkeypox vaccine?
Please note that there is a limited supply of the vaccine in New York state and nationwide, but more doses are expected in the upcoming weeks and months. 

If you believe you’re eligible for the vaccine, please contact your local health department or health care provider. They can help you determine whether you qualify for the shots and advise you on next steps. Here is more information on obtaining a vaccine in New York state.

As of right now, the federal government is providing vaccinations to states and jurisdictions most in need and at no cost to the individual. 


Q. What is my health insurance coverage for services related to monkeypox?
Coverage will vary based on the member’s situation and insurance plan. The following are general guidelines based on the type of health plan you have. If you have questions about coverage, please call the Customer Care number on the back of your member card.

 

Coverage guidelines

  1. These guidelines from New York state apply to members enrolled in the following plans:
    • Medicaid Managed Care, Child Health Plus, Essential Plan and Health and Recovery Plans (HARP)
    • Healthy New York
    • Medicare Supplemental
    • Direct Pay Qualified Health Plans
    • *Fully-insured employer plans
    • **Article 47/Municipal Cooperative Health Benefit Plans

The following will be covered at no cost to the member for the duration of New York state’s Disaster Emergency:

  • Monkeypox vaccinations (including the administration of the shots) from in-network and out-of-network providers
  • In-network laboratory testing to diagnose monkeypox
  • In-network doctor visits to diagnose monkeypox, including those conducted via telehealth or in a provider’s office, emergency room or urgent care setting.

Members, however, may have to pay costs for follow up care and treatment related to this disease. Additionally, a deductible may be applied for high deductible health plans.  What a member pays for follow up care and treatment will be based on the terms of the individual’s health insurance contract.

  1. These guidelines apply to members enrolled in the following plans:
    • Medicare Advantage
    • ***Self-funded employer plans (except Article 47/Municipal Cooperative Health Benefit Plans)
    • Federal Employee Plans

Please note that New York state coverage guidelines do not apply to these plans, so federal rules apply.

Coverage, if any, of Monkeypox vaccinations and treatment, along with lab tests and doctor visits to diagnose the disease, will be provided in accordance with the member’s health insurance contract.

Please note: The federal government is currently providing monkeypox vaccinations at no cost to the individual.

 

The information in this document was originally posted on Aug. 22, 2022, and updated Sept. 19, 2022.

* Fully-insured employer plans: A type of funding arrangement for an insurance plan in which the health insurer (and not the employer) assumes most of the financial risk for providing health coverage to employees.

** Article 47 Municipal Cooperative Health Benefit Plans: These are plans in which municipal organizations – such as school districts – join together to self-fund a health benefit plan for their employees

*** Self-funded employer plans: A type funding arrangement for a health benefit plan in which the employer (and not the health insurer) assumes the financial risk for providing health coverage to employees.

Contact:
Joy Auch, (585) 238-4374


Excellus BlueCross BlueShield, an independent licensee of the Blue Cross Blue Shield Association, is a nonprofit health plan with 1.5 million upstate New York members. The company's mission is to help people live healthier and more secure lives through access to high-quality, affordable health care. Its products and services include cost-saving prescription drug discounts, wellness tracking tools and access to telemedicine. With more than 3,500 employees, the company is committed to attracting and retaining a diverse workforce to foster innovation and better serve its members. It also encourages employees to engage in their communities by providing paid volunteer time off as one of many benefits. To learn more, visit ExcellusBCBS.com.

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