ALERT: Medicare May Not Be Covering Your COVID-19 Vaccine

Medicare beneficiaries are familiar with Medicare Part B and what it covers- all vaccines deemed necessary. But that does not extend coverage to those approved under emergency-use authorization, which is expected for an early administration of the COVID-19 vaccine.

If you’re on Medicare and hope to get a coronavirus vaccine as soon as it’s available, it may take an act of Congress for it to be free. It’s uncertain when a legislative fix could come or if there are regulatory maneuvers that could provide a work-around instead.

Timing is everything

As a handful of drug manufacturers fiercely work on a vaccine as part of the Trump administration’s push for the availability during this public-health crisis, an emergency-use authorization would fall short of the more rigorous approval process typically required by the Food and Drug Administration. 

“But there’s clearly a lot of scientific and medical firepower being thrown at the search for a COVID vaccine,” Cubanski added.

Who gets the vaccine first?

The intent by the Centers for Disease Control and Prevention would be to get the limited quantities first available to those most at risk for contracting COVID-19 or dying from complications caused by the virus.

That generally would include Medicare beneficiaries, the majority of whom are age 65 or older — an age group identified as high-risk. 

There are about 62.7 million individuals enrolled in Medicare, although not all are enrolled in Part B, which typically covers vaccines. (Some beneficiaries with health coverage elsewhere delay signing up for Part B and instead only get Part A — hospital coverage — because they usually pay no premiums).

The CARES Act not quick enough

The CARES Act, signed into law in March, has no cost-sharing for Medicare beneficiaries for a COVID-19 vaccine once it’s available. However, due to existing Medicare rules, the legislation would apply only to a vaccine that undergoes the standard approval process for new biologics — not one authorized under emergency use, which is how the Trump administration anticipates making a vaccine available quickly. 

“I think officials are realizing they don’t have a good solution besides going back to Congress and getting the statutory language changed,” said Juliette Cubanski, deputy director for the Kaiser Family Foundation’s program on Medicare policy.

Will legal action be taken?

It’s uncertain when a legislative fix would be proposed, or if there are regulatory maneuvers that could provide a work-around instead.

“This administration is committed to modernizing the Medicare program and delivering for our nation’s seniors to ensure access to a vaccine with no cost-sharing,” according to a statement provided to CNBC from the Centers for Medicare and Medicaid in response to questions about when and how the agency planned to resolve the issue.

What’s next?

The FDA is expected to soon release strict guidelines for the accelerated process that essentially would mean emergency approval wouldn’t come until at least November if not later.

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