Medicare and the COVID-19 Vaccine: What We Know Now

Health departments in all 50 states are distributing the vaccine to frontline healthcare workers, residents of long-term care facilities, and people of high risk.

As with all new health initiatives, there are many questions about the new vaccine, its risks and benefits, and how much it will cost. I’ve been carefully watching the latest news and research to give you the best information about Medicare and the COVID-19 vaccine. Here’s what I know so far, starting with the most important question: Will Medicare cover the COVID vaccine?

 

Will Medicare cover the COVID-19 vaccine?

The short answer is yes. When Congress passed the CARES Act in March 2020, it was already looking ahead to the development of a potential vaccine. The CARES Act requires Medicare Part B to cover FDA-approved COVID-19 vaccines at 100%. If you are a Medicare beneficiary, you will have no out-of-pocket costs for the COVID-19 vaccine.

The rule applies to those enrolled in Original Medicare as well as those covered by a Medicare Advantage plan. If your Medicare Advantage plan has a provider network, your insurer cannot charge you out-of-network fees for the vaccine even if you get it from a non-network provider.

Anyone covered by Medicare can get the COVID-19 vaccine at no charge from any provider who accepts Medicare.

What if I get a bill for the COVID-19 vaccine?

Because the CARES Act requires insurers to cover the COVID-19 vaccine, you shouldn’t get a bill for it. Deductibles and Medicare cost-sharing  requirements are waived for the vaccine.

However, if you get the vaccine during an office visit, you may still get a bill for services not related to the COVID shot.

 

When can I get the COVID-19 vaccine?

Although manufacturers are ramping up production of the vaccine, only a limited number of doses are currently available. The government is allocating vaccines to the states based on population. It’s up to the states to determine how to distribute the vaccine.

The CDC recommends a four-phase approach:

  • Phase 1a– Frontline healthcare providers, first responders, and nursing home residents
  • Phase 1b– Essential workers in high-risk professions including education, public utilities, agriculture and food production, emergency services, and transportation
  • Phase 1c– People age 65 and over and those with serious underlying conditions
  • Phase 2– Those with underlying health factors, workers and residents of homeless shelters, group homes, and prisons
  • Phase 3– Young adults and children (if the vaccine is approved for them), workers in second-tier industries including financial services, higher education, and travel
  • Phase 4– All other U.S. residents

Not all states will follow the CDC’s guidelines exactly. Some consider other factors in the distribution schedule. Kentucky, for example, is allocating two-thirds of its first batch of vaccines to residents and staff of long-term care facilities. Tennessee is prioritizing the vaccine for healthcare workers age 65 and over.

States are also in charge of who administers the vaccines. Some states are using private hospital systems to distribute and administer the vaccine. Others are assigning the job to local health departments. Florida, for example, sent its vaccine to hospitals in five major cities for distribution while Illinois tasked its public health staff with giving the COVID shots.