This article was updated on October 29, 2020.
We recently reported that the Centers for Medicare and Medicaid Services (CMS) was working hard to offer a free vaccine to Medicare and Medicaid beneficiaries. Now the news has been released that CMS WILL cover a vaccine for seniors. Not only that, but a vaccine will also be free to those on Medicaid, Children’s Health Insurance, private insurance, and those without insurance once it becomes available.
CMS Administrator Seema Verma stated, “And even individuals that are uninsured – we’re going to be using some of the provider relief funds so if there’s somebody there that doesn’t have health insurance, that those costs will be covered so that nobody’s paying anything for the vaccine.”
Emergency use authorization
In the previous rule based on the CARES Act, an early vaccine approved by the FDA under emergency use authorization would NOT be covered under Medicare. But CMS has issued a new rule that will provide coverage for seniors and all Americans.
At least two top vaccine makers plan to apply for emergency use authorization before the end of 2020. When an early vaccine becomes available, the government will make it available to seniors and those most at risk first.
Covering the vaccines will cost Medicare around $3 billion, and the funds will come from the Medicare Trust Fund.
Verma promised to cover vaccine
Seema Verma, The Centers for Medicare and Medicaid Services’ (CMS) Administrator, promised to do everything in her power to make sure that a COVID-19 vaccine will be made available to seniors at no cost once a vaccine is approved. Verma continued to make known the importance of senior Americans and their value to the Trump Administration.
CMS’s efforts to protect seniors
As those at high-risk for COVID-19, seniors should not have any barriers, including financial, to receive the upcoming vaccine. Verma promised that CMS is working to guarantee a free vaccine for Medicaid and private insurance members as well.
“We also just want to make sure that all of our rules make it very clear to insurers that we want to make sure that every American can have access to these vaccines. The government’s going to pay for the costs of the vaccines, so we want to make sure insurance companies and all the programs across the country ensure that people have timely access and that cost is not a barrier,” said Verma.
More access to COVID-19 treatments
Also, CMS has been working on getting Medicare and Medicaid members access to COVID-19 treatments.
“We want to make sure that our payment policies aren’t standing in the way of beneficiaries having access to the latest treatments,” Verma said.
As is customary with government-purchased vaccines, healthcare professionals could charge insurers for the cost of administering the vaccine, the Department of Health and Human Services said in July.
Success with telehealth
Of all the regulatory measures CMS took during the pandemic, the one that stands out the most is the agency’s policy updates on telehealth.
“We very quickly tried to remove all the regulatory burdens around telehealth, making sure all providers could offer the services in different settings, getting rid of the regulations that require in-person visits,” Verma said. “And we did that very quickly. And I think that’s one of the efforts that we made that certainly saved many lives across the country.”
Making sure that telehealth is an option for everyone is a priority for CMS, Verma said. While the agency has done the work to make it available for Medicare and Medicare Advantage beneficiaries, Congress needs to do its part in expanding access for all patients, she said.
“We’re looking at our regulatory flexibilities,” Verma said. “We do need Congress to help us to make sure that telehealth can be provided outside of rural areas, that people can get these services from [their] home.”
Continuation with lowering drug prices
“We are actively engaged around working with our CMMI (Centers for Medicare and Medicaid Innovation) team around a model that would give us lower prices in Part B and ensure that Americans and our seniors are getting the best deal,” promised Verma.