Coronavirus Vaccine: Will Medicare Cover It?

Medicare will cover the vaccine for the new coronavirus. The CARES Act of March 2020 specifically states that “coverage of the COVID-19 vaccine” is taken care of by Medicare Part B.

But what about people with a Medicare Part C (Medicare Advantage) plan?

Because these plans are required to include the basic coverage given by original Medicare (parts A and B), those with an Advantage plan will also be covered.

People without original Medicare or Medicare Advantage may be able to receive a vaccine free of charge as well, at least initially.

This is because almost all people in the United States, regardless of whether they have health insurance, will be eligible for a free vaccine for the foreseeable future.

DID YOU KNOW?

Medicare Part B generally covers the commonly administered vaccines for hepatitis B, flu, and pneumonia. It also covers vaccines that are needed as a result of injury or direct exposure to a disease.

Medicare Part D generally covers all other commercially available vaccines that aren’t covered by Part B.

There are currently two vaccines authorized to prevent COVID-19. They are the Pfizer-BioNTech COVID-9 vaccine and the Moderna COVID-19 vaccine.

Vaccine supply is currently limited to certain population groups. However, it’s the goal of the CDC to have these vaccines widely available to the general public within the coming months at no cost.

A vaccine from Johnson & Johnson has just been determined to be safe and effective by the FDA and has been approved for an EUA.

AstraZeneca has also developed a COVID-19 vaccine that has been approved for emergency use in Europe and other countries, and may receive a U.S. EUA sometime in April.

Vaccines, like other drugs, must undergo rigorous testing and clinical trials to make sure that they’re both safe and effective.

Research into vaccines for the new coronavirus has exploded in recent months.

In fact, a report from the World Health Organization (WHO) found that there are more than 200 vaccine candidates currently in development.

Only around 30 of these candidates have entered phase 1 clinical trials. This type of trial is designed to assess the safety of the vaccine in a small group of healthy volunteers.

Around 10 vaccines have entered phase 3 clinical trials. Phase 3 clinical trials typically involve thousands of volunteers.

As of December 23, 2020, seven vaccines have received authorization or approval from government agencies around the world. They are:

• BNT162b2 from Pfizer and BioNTech
• mRNA-1273 from Moderna
• CoronaVac from Sinovac Biotech
• an unnamed vaccine from the Wuhan Institute of Biological Products and Sinopharm
• Sputnik V from the Gamaleya Research Institute and the Acellena Contract Drug Research and Development
• BBIBP-CorV from the Beijing Institute of Biological Products and Sinopharm
• EpiVacCorona from the State Research Center of Virology and Biotechnology VECTOR

On December 11, 2020, the Food and Drug Administration (FDA) announced that it would grant an emergency use authorization (EUA) for the Pfizer-BioNTech vaccine.

On December 18, the FDA issued an EUA for Moderna’s vaccine.

Receiving an EUA means that the vaccines will be made available to the public even though they haven’t received FDA approval. EUAs are issued in circumstances when no FDA-approved alternatives are available to help diagnose, treat, or prevent a serious condition.

The strategies used to develop these vaccines are very diverse. Many of them focus on generating antibodies to SARS-CoV-2’s S protein. This is the protein that the coronavirus uses to attach to and enter a host cell.

If you think you may be sick with COVID-19, Medicare will cover many of your health needs.

Medicare Part B covers the cost of testing to determine whether you have COVID-19. You’ll pay nothing for the test.

Part B also covers the cost of other tests that are medically necessary to help diagnose COVID-19. One example of this is a CT scan of your lungs.

You’ll typically pay 20 percent of the total cost after meeting your Part B deductible. The deductible and coinsurance is $203.

It’s likely that people who become sick will need to use a variety of inpatient and outpatient services as they recover.

So what exactly does Medicare cover? Let’s answer some questions you may have below.

Medicare Part B covers the costs of outpatient doctors’ visits. After meeting your deductible, you’re often responsible for paying 20 percent of the total cost.

Coverage of telehealth visits has also expanded during the pandemic. Telehealth visits are virtual visits with a doctor instead of face-to-face visits in an office.

After you’ve met your Part B deductible, you’ll pay 20 percent of the total cost.

If your doctor prescribes medication to help treat COVID-19, Medicare Part D can cover this. Part D is prescription drug coverage.

People with original Medicare can purchase a Part D plan. Part D is included in many Advantage plans.

The FDA has approved remdesivir (Veklury) for the treatment of COVID-19. The agency has also granted EUAs to other prescription COVID-19 medications, including:

• bamlanivimab
• casirivimab and imdevimab, which must be taken together

The drugs mentioned here are all intravenous (IV) infusion treatments.

Doctors prescribe remdesivir to people who are hospitalized. The other drugs can be given as outpatient therapies. They’re used to limit the risk of hospitalization in people with less severe illness.

If you’re admitted to a hospital due to COVID-19, Medicare Part A will cover these costs.

You’ll be responsible for a $1,484 deductible for your benefit period and for a daily coinsurance beginning after day 60.

Part A covers services such as:

• your room
• your meals
• general nursing services
• medications given as part of your inpatient treatment
• other hospital supplies or services

Part A also covers people who would have normally been discharged but need to stay under quarantine at a hospital or other inpatient facility.

Additionally, Part B covers most doctors’ services that you receive while you’re an inpatient at a hospital.

Medicare Part B will cover ground transportation in an ambulance to the nearest hospital. After meeting your deductible, you’ll pay 20 percent of the total cost.

Advantage plans are required to offer the same basic set of benefits as original Medicare (parts A and B). Because of this, if you have an Advantage plan, you’ll be covered for the same services discussed above.

Some Advantage plans may offer expanded telehealth benefits. Additionally, prescription drug coverage is included in many Advantage plans.

Which parts of Medicare cover COVID-19?

Let’s do a quick recap of which parts of Medicare cover COVID-19:

• Part A covers inpatient stays at locations such as a hospital or skilled nursing facility.
• Part B covers outpatient visits and services, some inpatient services, COVID-19 testing, the coronavirus vaccine, telehealth visits, and ambulance services.
• Part C (Medicare Advantage) covers the same basic benefits as parts A and B. It may also offer expanded telehealth coverage.
• Part D covers prescription drugs.
• Supplement insurance (Medigap) helps pay for deductibles, coinsurance, and copays that aren’t covered by parts A and B.

Scientists are currently working to develop multiple vaccines for the new coronavirus. Some vaccines have already entered clinical trials and been deemed safe and effective.

The FDA has issued EUAs for three of them already, so vaccines for the new coronavirus will be available to the public soon.

When vaccines are available to the public, Medicare Part B and Medicare Advantage will cover them.

In fact, for the foreseeable future, vaccines will be free for almost everyone in the United States regardless of whether they have health insurance.

Medicare also covers many of the health services that you may need if you become ill with COVID-19. Examples include but aren’t limited to treatment, doctors’ visits, and hospitalization.