COVID-19 Vaccine to Administered at No Cost to Medicare Beneficiaries

On Thursday, October 29, 2020, The Centers for Medicare and Medicaid Services (CMS) issued a comprehensive plan with proactive measures to remove regulatory barriers and ensure consistent coverage and payment for the administration of and eventual vaccine for millions of Americans. The vaccine and its administration will be added to the list of preventive vaccines that are covered under Medicare Part B without coinsurance or deductible. Please see below for a summary of that CMS notice.

Coverage Information for Medicare Beneficiaries

As a condition of receiving free COVID-19 vaccines from the federal government, providers will be prohibited from charging consumers for administration of the vaccine.To ensure broad and consistent coverage across programs and payers, COVID-19 toolkits have be sent to providers with specific information for several programs, including:

Medicare

Beneficiaries with Medicare pay nothing for COVID-19 vaccines and their copayment/coinsurance and deductible are waived.

Medicare Advantage (MA)

For calendar years 2020 and 2021, Medicare will pay directly for the COVID-19 vaccine and its administration for beneficiaries enrolled in MA plans. MA plans would not be responsible for reimbursing providers to administer the vaccine during this time. Medicare Advantage beneficiaries also pay nothing for COVID-19 vaccines and their copayment/coinsurance and deductible are waived.

Medicaid

State Medicaid and CHIP agencies must provide vaccine administration with no cost sharing for most beneficiaries during the public health emergency. Following the public health emergency, depending on the population, states may have to evaluate cost sharing policies and may have to submit state plan amendments if updates are needed.

Private Plans

CMS, along with the Departments of Labor and the Treasury, is requiring that most private health plans and issuers cover a recommended COVID-19 vaccine and its administration, both in-network and out-of-network, with no cost sharing. The rule also provides that out-of-network rates cannot be unreasonably low, and references CMS’s reimbursement rates as a potential guideline for insurance companies.

Uninsured

For individuals who are uninsured, providers will be able to be reimbursed for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by the Health Resources and Services Administration (HRSA).


You may view the full CMS press release for additional information.

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Updated October 1, 2020

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