Will Medicare Cover The Cost of a COVID Vaccine?
With the coronavirus pandemic responsible for more than a hundred thousand deaths and disrupting life across the United States, the only way for the country to return to normal is an effective vaccine. When a vaccine is available, Medicare will most likely cover the cost. But there is a chance it might not.
How Will Medicare Cover The COVID Vaccine?
Medicare covers vaccines in a variety of ways, depending on the vaccine. It may be through Medicare Part B, Medicare Part D, or a Medicare Advantage plan if you are enrolled in one. Part B covers vaccines only for certain illnesses: flu, pneumonia, and Hepatitis B (if you are at medium or high risk). Medicare covers 100 percent of the cost of these vaccines if you go to an approved provider, and you do not have to pay a deductible or coinsurance. Medicare Advantage is also required to provide these vaccines at no additional costs.
In What Situation Would Medicare Not Cover the Cost?
While Medicare would cover a coronavirus vaccine approved through normal channels, if the Food and Drug Administration approves the vaccine through an emergency use authorization (EUA), Medicare will not cover it unless the government acts. The CARES Act provides that if a COVID-19 vaccine becomes available, Medicare is required to cover this vaccine under Part B with no cost-sharing. Medicare Advantage plans are required to include the basic coverage offered by Medicare Parts A and B, so this coverage also applies to beneficiaries in Medicare Advantage plans.
However, it is possible that the federal government will authorize the use of the vaccine through an EUA, which is a faster method of approving drugs needed in a crisis situation, like the coronavirus pandemic. Medicare does not cover the costs of vaccines approved under EUAs. One way to ensure that the COVID vaccine would be free is for Congress to change the language in the CARES Act to ensure coverage. In addition, doses purchased by the federal government will be free of charge.
The Emergency Use Authorization (EUA) authority allows the FDA to protect the nations’ public health against chemical, biological, radiological, or nuclear (CBRN) threats by facilitating the availability and use of MCMs needed during public health emergencies.
Under section 564 of the Federal Food, Drug, and Cosmetic Act (FD&C Act), the FDA Commissioner may allow unapproved medical products or unapproved uses of approved medical products to be used in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions caused by CBRN threat agents when there are no adequate, approved, and available alternatives.
What are MCMs?
Medical countermeasures, or MCMs, are life-saving medicines and medical supplies regulated by the U.S. Food and Drug Administration (FDA) that can be used to diagnose, prevent, protect from, or treat conditions associated with CBRN threats, emerging infectious diseases, or a natural disaster.
- Lab tests for COVID-19 – You pay no out-of-pocket costs.
- FDA-authorized COVID-19 antibody tests – If you were diagnosed with a known current or prior COVID-19 infection or suspected COVID-19 infection.
- All medically necessary hospitalizations – If you are diagnosed with COVID-19 and need to stay in the hospital under quarantine. You’ll still pay for any hospital deductibles, copays, or co-insurances that apply.
- Medicare Advantage Plan – Medicare allows these plans to waive cost-sharing for COVID-19 lab tests. Many plans offer additional telehealth benefits and expanded benefits, like meal delivery or medical transport services. Check with your plan about your coverage and costs.
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