Will Medicare Cover the Covid-19 Vaccine?

Will your healthcare cover the Covid-19 Vaccine?

Listening to the news we are all hearing about the nearing release of a Covid-19 vaccine. Among some misgivings, the vaccine appears to work at above 90% efficacy and will soon be distributed to the public… well some of the public.

The first recipients of the vaccine will be front-line workers, those who haven’t been able to stay tucked away at home and are keeping our world running on a day-to-day basis. Next will be people residing in nursing homes and assisted living communities. Then the third group to receive the vaccine will be people 65 and older. Those three groups alone represent millions of Americans. The vaccine is estimated to be distributed to these three groups by the Spring of 2020, with wider release to the general public beginning in the summer of 2020.

That being said, if you’re one of the three priority groups, you might be wondering “can I even afford this vaccine?” If you are enrolled in Medicare, the answer is yes. Unlike other vaccines that may cost a co-pay or out of pocket cost if you’re out of network, the Covid-19 vaccine is required to be covered by Medicare part B under the CARES Act. For Advantage plans, they are required to provide basic coverage offered by Part A and B meaning the coverage will also extend to Medicare Advantage plans.

What would the pharmaceutical companies and providers get? According to CMS, “The Medicare payment rates will be $28.39 to administer single-dose vaccines,” the press release explains. “For a COVID-19 vaccine requiring a series of two or more doses, the initial dose(s) administration payment rate will be $16.94, and $28.39 for the administration of the final dose in the series.” - Healthpayer Intelligence

The hope is that by the time these three groups receive the vaccine, the population will move toward herd immunity and we will live in a much different world come the end of 2021.

Stay strong, stay hopeful and stay connected. Doctor’s Choice is always here for you and happy to help however we can.