Does Medicare Pay For COVID-19 Vaccine?
Many Medicare beneficiaries have been hesitant to get the vaccine because of concerns about cost. However, original Medicare and Medicare Advantage plans both cover the vaccine. In addition, some Medicare Advantage plans offer expanded telehealth coverage.
Medicare beneficiaries will continue to get the vaccine free of charge after the COVID-19 pandemic ends, whether they have original Medicare or a Medicare Advantage plan. This is because the CARES Act specifically states that vaccines covered under Part B are considered Medicare services and, therefore, not subject to any cost-sharing, such as deductibles or copayments. The vaccine coverage under Part B will also remain free for individuals who use telehealth services to receive the vaccination. These benefits will stay in place until the end of 2024.
However, it is important to remember that facilities are allowed to add an administrative fee on top of the cost of the vaccine. This is to cover the cots of their staff, supplies, and facilities. But you should be aware of these fees and double-check your Medicare Summary Notice or Explanation of Benefits for any suspicious charges.
In addition to Medicare Part B, most Marketplace plans will also continue to cover the vaccine without any out-of-pocket costs. The exception is if you enroll in an Advantage plan with an out-of-network provider who has not signed an agreement with your specific Medicare Advantage organization. If you have a Medicare Advantage plan with an out-of-network doctor, you may be responsible for an additional fee to the doctor or office for administering the vaccine.
Shingrix Vaccine Coverage
The ACA requires most private insurance to cover ACIP-recommended vaccines, including COVID-19 vaccines. The CARES Act shortened this requirement to 15 days after the vaccine is recommended by ACIP, irrespective of whether it’s under an emergency use authorization or fully approved by the FDA. However, a few plans, like some grandfathered or Short-Term Limited Duration (STLD) plans, can still require cost-sharing for vaccines.
Medicare Part D covers the COVID-19 vaccine for people at high risk for severe symptoms or who have had a past COVID-19 infection. It also covers the Shingrix vaccine for shingles and other vaccines for diseases that affect older adults. Unlike the flu vaccine, most of these other vaccines are covered without a deductible or copayment. The exception is the shingles vaccine, which has a small out-of-pocket cost under Medicare Part D. This is because it’s a newer vaccine and has not yet been tested, as well as the other older vaccines.
