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Will health insurance cover the COVID-19 vaccine?

The vaccine will be free for as long we’re in a state of emergency — but with a priority list.

The COVID-19 pandemic has plagued the US for the better part of 2020, and several vaccines are in development. With Moderna, Pfizer and AstraZeneca reporting positive results from their vaccines, it’s possible the FDA will approve an emergency use authorization soon.

Americans will have access to free COVID-19 vaccines once they become available — though some people may have to wait.

Will the COVID-19 vaccine be free?

Yes. All Americans will have access to the COVID-19 vaccine at no cost, according to new legislation announced by the Centers for Medicare & Medicaid Services (CMS) on October 28, 2020.

Known as the Interim Final Rule with Comment Period, the legislation lays out beneficiaries’ rights as well as how insurers should handle billing and reimbursement.

The announcement specifies how each type of insurance will treat the coronavirus vaccine, and the regulations will go into effect immediately.

Type of health insuranceWill it pay for the coronavirus vaccine?
Employer-sponsored and individual health insurance plansYes — as a preventative service, with no cost sharing.

This aligns with the Affordable Care Act (ACA) mandates, and means you won’t pay a copay, coinsurance or deductible.

You’ll be able to get the vaccine both in and outside your network.

MedicareYes — and any copays, coinsurance and deductibles will be waived.

For context, Medicare typically doesn’t pay for vaccines that receive “emergency use authorization” from the FDA — but the new legislation allows for that.

The US government will pay insurers to administer the vaccine swiftly.

Medicaid and Children’s Health Insurance PlansYes — for as long as the coronavirus is a public health emergency.

When the pandemic is no longer an emergency, states may evaluate cost-sharing policies and submit changes to the CMS.

What if I don’t have health insurance?

You can get the vaccine at no cost under the new legislation. The federal government set up the Provider Relief Fund to pay healthcare providers who vaccinate uninsured people.

The fund will be managed by the Health Resources and Services Administration, though we don’t know much more at this point.

What does “emergency use authorization” mean?

For a drug, device or vaccine to be approved by the FDA, it needs to undergo extensive research and testing — which typically takes a few years.

But the FDA can issue emergency use authorizations, which authorizes products for as long as the public health emergency lasts. Testing is less comprehensive for an authorization, and the product goes through the rigorous testing process once the emergency is over.

The coronavirus was declared a public health emergency on January 31, 2020. With infection rates increasing around the world, the emergency likely won’t be lifted any time soon.

Ask an expert: Are there any Medicare plans that don’t cover the full cost of the vaccine?

Christian Worstell

Christian Worstell
Licensed health insurance agent at MedicareAdvantage

Original Medicare is required to cover the cost of the COVID-19 vaccine in full as long as you receive the shot from an approved provider. No deductible or coinsurance will apply. Medicare Advantage plans are required by law to provide the same benefits as Original Medicare and thus are also required to cover the full cost of the vaccine at no charge to the patient. Medicare beneficiaries should not pay anything out of pocket for the vaccine regardless of their Medicare plan.

Will Medicare cover any care needed for reactions to the COVID-19 vaccine?
Medicare will cover any adverse reactions to the COVID-19 vaccine in the same manner that it will cover treatment for those things under any circumstances. If treatment for a medical condition is covered by Medicare, it will be covered the same way regardless of whether or not the condition resulted from the vaccine.

Who will get the COVID-19 vaccine first?

Healthcare workers and nursing home residents should be prioritized, according to the CDC’s Advisory Committee on Immunization Practices — a panel made up of health and immunization experts. They met on December 1st to vote on how the COVID-19 vaccine will be distributed once approved.

“Healthcare settings in general, and long-term care settings in particular, can be high-risk locations for SARS-CoV-2 exposure and transmission,” the Advisory Committee said when explaining their decision.

“As of December 1, 2020, approximately 245,000 COVID-19 cases and 858 COVID-19-associated deaths had been reported among US healthcare personnel. Early protection of healthcare personnel is critical to preserve capacity to care for patients with COVID-19 or other illnesses.”

“Long-term care facility (LTCF) residents, because of their age, high rates of underlying medical conditions, and congregate living situation, are at high risk for infection and severe illness from COVID-19. As of November 15, 2020, approximately 500,000 COVID-19 cases and 70,000 associated deaths had been reported among residents of skilled nursing facilities, a subset of LTCFs serving residents with more complex medical needs.”

To give you an idea of the size of this group, approximately 21 million Americans work in healthcare settings such as hospitals and outpatient clinics, and there are 3 million people in nursing homes across the US.

If the CDC accepts the recommendations, that will become official guidance for federal and state officials. We will update this page when we have confirmation.

Bottom line

Thanks to new legislation, insurers and healthcare providers aren’t allowed to charge patients for the COVID-19 vaccine. Once it becomes available, it will be available at no cost to all Americans — including those on Medicare and Medicaid and the uninsured.

In the meantime, stay on top of changing coronavirus news as it relates to your finances and health.

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