Will Health Insurance Cover A Covid 19 Vaccine?
Will Health Insurance Cover A Covid 19 Vaccine?
In an effort to curb the rapid spread of the coronavirus, the federal government has invested billions of dollars in the research and development of the Covid-19 vaccine. And to ensure wide-scale immunization, the federal government has purchased millions of multiple Covid-19 vaccine doses and distributed them to providers for free, who will then administer to individuals.
You’re probably wondering if your health insurance will cover the Covid-19 vaccine or if the vaccine will carry unexpected costs like co-pays. Well, here’s how your health insurance covers the Covid-19 vaccine and how you can get coverage.
Will Health Insurance Cover The COVID-19 Vaccine?
Early in the pandemic, the federal government passed laws to ensure everyone would receive the vaccine at zero cost, regardless of their insurance status. Whether you’re insured or uninsured, you will be able to receive a Covid-19 vaccine at no cost over the public health emergency period, which is currently effective through April 20, 2021.
While it’s unclear how much the Covid-19 vaccine will cost after the public health emergency duration ends, you should expect a change in coverage that may require you to pay part of the administration costs. As such, it’s crucial that you understand specifics about your health insurance plan.
While health insurance plans vary, listed below are some general guidelines.
Private Health Insurance
If your plan is private health insurance, the COVID-19 vaccine will be covered as a preventive service. This means that if you’re insured by a private health plan through your employer’s group insurance plan or through an ACA marketplace plan, your insurer will provide coverage for the Covid-19 vaccine without cost-sharing as required by the essential health benefits guidelines.During the PHE, if you’re in an individual plan or non-grandfathered group, your carrier is required to offer coverage for your Covid-19 vaccine whether the vaccination is done by an in-network or out-of-network vaccine provider. This benefit falls under ACA’s preventive care guidelines.
Several insurance carriers such as Blue Cross Blue Shield and Aetna have already stated that they will not charge people for the Covid-19 vaccine or its administration.
However, you may be charged a deductible, coinsurance, or copayment for vaccine administration if your doctor’s visit includes additional, non-COVID-19 health care services.
SHBP and SEHBP Plans
If you are covered by SEHBP or SHBP, your insurer will provide coverage for the coronavirus vaccine and its administration without deductible or coinsurance for in or out of network providers.
Medicare and Medicare Advantage plans
If you have a Medicare health plan under part B or a Medicare Advantage plan, the coronavirus vaccine and its administration will be covered at 100 percent with no cost-sharing under the CARES Act.Typically, Medicare Advantage plans offer the same basic coverage as those under Medicare Parts A and B, meaning you’ll get the same coverage as a Medicare Advantage plan beneficiary. However, your Medicare Advantage plan’s coverage may need you to use a provider in your plan’s network.
Medicaid
For Medicaid programs, Covid-19 vaccine administration will be covered in full for the public health emergency period. This will vary based on your eligibility category, which in most cases will comprise adults and children under ACA’s traditional Medicaid and the Medicaid expansion.Also, the coverage will include the Coronavirus vaccine and its administration without cost-sharing for both in and out of network providers.
However, the coverage requirement does not apply to limited benefit Medicaid plans like ones that offer Medicaid coverage for tuberculosis services or family planning services only.
Exceptions
ACA-unregulated plans are exempt from the government’s vaccine coverage requirement. However, some of these insurers may willingly offer coverage for the Covid-19 vaccine or its administration during and even after the public health emergency.
These health insurance plans include:
Farm Bureau plans
Short-term medical plans
Health care sharing ministry plans
Fixed, limited coverage indemnity plans
Federal requirements do not apply to any of these plans, meaning they are not obliged to offer coverage for preventive services, which includes a covid-19 vaccine. As such, you should find out from your plan administrator the type of coverage limitations or restrictions that may apply in regard to the Covid-19 vaccine or its administration.
Can I Receive A COVID-19 Vaccine Without Any Health Insurance Cover?
Although there is no federal requirement that carriers offer coverage for the Covid-19 vaccine to uninsured Americans, the government has provided funding for COVID-19 vaccine administration to the uninsured people.
“What makes the vaccine protections unique is that there are requirements on both the insurers and the providers. It’s a belt-and-suspenders approach that makes the consumer protections much stronger,” stated Karyn Schwartz, a senior fellow at the Kaiser Family Foundation.
This means that you’ll be able to receive the Covid-19 vaccination even if you’re uninsured under the Health Resources and Services Administration (HRSA) COVID-19 Uninsured Program.
Then the provider submits a reimbursement claim for the administration service to the federal Provider Relief Fund. The U.S. Department of Health and Human Services (HHS) handles the fund and is responsible for reimbursing healthcare providers.
However, you may be charged by the provider, if they don’t submit a bill to the Provider Relief Fund for reimbursement.
“If the provider doesn’t submit a bill for COVID-19-related testing and/or treatment to the HRSA COVID-19 Uninsured Program, or the care was not eligible for reimbursement from the program, the patient may be responsible for full payment of the bill,” stated the HRSA spokesperson.
With that in mind, if you’re insured and you get a bill for your COVID-19 vaccine, you should consider filing a claim with your insurance provider. On the other hand, if you’re uninsured, it is important that you find a provider who is in the Provider Relief Fund.