At the end of 2020, biotech companies such as Moderna and Pfizer, obtained emer- gency use authorization from the Food and Drug Administration (FDA) to administer COVID-19 vaccinations. These vaccines are reportedly more than 94% effective in warding off the novel virus, as well as lowering serious side effects.
As of April 2021, more than 230 million doses have been given, and over 96 million people are fully vaccinated in the United States. Until recently, the majority of vaccines were prioritized to frontline workers, and people 65 years of age and older. President Joe Biden moved up the eligibility target for all American adults to receive the COVID-19 vaccine, but many states around the country had already opened up criteria that anyone over the age of 16 is eligible to receive the vaccine.
Who is Paying for the Vaccinations?
The federal government invested in the preliminary supply of COVID-19 vaccines. Because of this, Americans can receive the vaccine at no cost (procured with U.S. taxpayer dollars).
Officials reported that people should not pay out-of-pocket (in 2020 and 2021) to receive the vaccine during the pandemic, even if they do not have insurance; however there may still be an administration charge for the vaccine.
Medicare: COVID-19 vaccinations that are FDA-approved will be fully covered under Medicare Part B. Medicare.gov states that, “you pay nothing for this vaccine.”
Medicaid: For individuals who have Medicaid coverage, they should also be able to obtain the vaccine for free. States that collected supplementary Medicaid funds (under the Families First Coronavirus Response Act), does not automatically include people who are covered by limited benefit Medicaid programs. Post-pandemic, the price of the vaccine for this population who are covered by Medicaid will probably be decided by eligibility categories.
Private Health Insurance: For almost all individuals who have private health insurance, the CARES Act requires full coverage of the COVID-19 vaccine. There are several insurance companies who have publicized that patients will pay zero fees, both for the vaccine itself or administration costs.
When the pandemic is behind us, it is estimated that individuals who are uninsured will likely pay anywhere from $24 to $57 per dose.
Resources for Healthcare Providers
If a provider participates in the COVID-19 Vaccination Program, they must agree to:
- Dispense the vaccine with zero out-of-pocket costs to their patients.
- Vaccinate every person who would like the protection, including the uninsured.
Providers must also agree to abstain from the following:
- Bill patients for an “office visit” or any other fee if COVID-19 vaccination is the sole medical service supplied.
- Expect ancillary medical services during the same visit in order to receive the vaccination.
The Centers for Medicare & Medicaid Services (CMS) supplied toolkits for providers and insurers. They are intended to help healthcare systems quickly administer vaccines, grow the number of providers who are able to provide the vaccine, make sure there is sufficient Medicare payment, and assist private insurers and Medicaid programs to better understand their responsibility to fully finance the vaccine.
How to Enroll as a Centralized Biller
If your business is a mass immunizer, a centralized billing system can be used to send all COVID-19 vaccine roster bill claims. Medicare will pay out based on where the vaccine was administered. Businesses can enroll and utilize this centralized billing no matter where the vaccines were administered.
Providers who have vaccine billing or reimbursement questions for privately insured patients or Medicaid should contact the respective health plan. Providers who are dispensing the vaccine to individuals without health insurance can petition repayment for administrating the COVID-19 vaccine through Health Resources & Services Administration’s (HRSA) uninsured program.
For more information on the COVID-19 pandemic, including mental health resources and tracking the vaccination developments, visit our Auxo Medical blog archives.