Do You Need to Pay Anything Out of Pocket for a COVID-19 Vaccination? Dena Bunis, AARP

 

The vaccine is free, but doctors still get reimbursed for giving shots. Here's how it works.

As you prepare to go to your local health center, pharmacy or even football stadium to get a COVID-19 vaccination, you'll probably need to show a current ID and health insurance card, if you have coverage. One thing you shouldn't have to bring is payment for the shot.

The coronavirus vaccine “must be provided to vaccine recipients with no out-of-pocket costs,” according to the Department of Health and Human Services (HHS). And while the federal government is picking up the cost of the tens of millions of vaccine doses Americans across the country are getting, the doctors, nurses and other health care providers will still get paid for administering the vaccines.

Here's how it works

Medicare

Beneficiaries cannot be charged for the vaccine by providers who participate in the Medicare program. All copays and coinsurance payments by patients are also waived. This applies to all Medicare enrollees — whether they are enrolled in original Medicare or a Medicare Advantage private insurance plan.

Providers who participate in Medicare will receive an administrative fee for giving COVID-19 vaccine shots to patients. The Centers for Medicare & Medicaid Services (CMS) has established a fee schedule for the two-dose vaccines, such as the Pfizer-BioNTech and Moderna vaccines, that gives providers $16.94 for the first dose and $28.39 for the second. If any single-dose vaccines are authorized, Medicare will pay providers $28.39 for that shot.

Health insurance plans that were in effect before the ACA (2010) and short-term insurance plans – both of which do not have to be ACA-compliant – are not required to cover the COVID-19 vaccine at no cost. They can request reimbursement from the HHS provider relief fund but cannot bill patients directly.

CMS suggests that if the beneficiary is charged by a Medicare provider for administering the vaccine, they contact the Medicare hotline at 1-800-MEDICARE (1-800-633-4227) to report the charge. If Medicare actually pays the provider for giving the vaccine, the beneficiary would be entitled to a refund.

Private insurance

Don't be thrown if when you register for a vaccine or get to a site, you're asked for your health insurance card. During this public health emergency, most private health insurance plans will be required to cover all the costs of a COVID-19 vaccine.

You still shouldn't have to pay a copay, coinsurance or any other fee to get the vaccine. And that applies even if you go to an out-of-network provider. Whoever is giving you the vaccine — even someone at a pharmacy — needs your insurance information so they can be reimbursed by your plan for putting the shot in your arm.

Health insurance plans that were in effect before the ACA (2010) and short-term insurance plans – both of which do not have to be ACA-compliant – are not required to cover the COVID-19 vaccine at no cost. They can request reimbursement from the HHS provider relief fund but cannot bill patients directly.

Uninsured and Medicaid Patients

Even if you do not have health insurance you can get a COVID-19 vaccine for free. As part of the CARES Act coronavirus legislation signed into law last March, providers who administer a COVID-19 vaccine to someone who is uninsured will be reimbursed as part of a provider relief fund the law created. The same applies to Medicaid beneficiaries. The relief fund will also pay providers who inoculate Medicaid recipients who have limited Medicaid benefits that do not cover vaccines.