Title: Delays in Health Insurance Coverage for New COVID Vaccines Cause Concern Among Patients
Subtitle: Some patients bear unexpected costs as government and private insurers update their plans
The nationwide rollout of the latest round of COVID-19 vaccines in the United States has encountered initial obstacles as patients report delays in health insurance coverage for the shots. The arrival of the highly anticipated Pfizer and Moderna booster shots late last week has been met with confusion and frustration among those seeking vaccination.
Under federal regulations, private insurance plans and government payers such as Medicare are required to cover the new vaccines. The Centers for Medicare & Medicaid Services (CMS), along with some private health-care providers and CVS, have confirmed the temporary delays in insurance coverage. They reassured Americans that the COVID vaccines can be accessed at no cost through insurance plans. The reason for the delays, they explained, is that some insurers are still working to update their plans to include coverage for the new vaccines.
Unfortunately, numerous social media posts over the past few days have revealed that some patients have been charged between $125 and $190 for a vaccine shot at pharmacies. Others have been informed that their insurance plans do not yet cover the new vaccines. This conflicting information has resulted in confusion among insured patients who are unsure whether they can still receive the COVID shots for free.
The recent coverage missteps have exacerbated concerns about the uptake of the new vaccines, especially as COVID cases continue to rise across the country. Public health officials have repeatedly urged all eligible Americans, ages 6 months and up, to receive the new round of vaccines to combat the spread of the omicron subvariant XBB.1.5.
This bumpy start in the vaccine rollout follows a significant shift in how COVID vaccines are covered in the U.S. Previously, the federal government purchased vaccines directly from manufacturers at a discount and distributed them to all Americans for free. However, now the shots are being shifted to the commercial market, where manufacturers sell them directly to healthcare providers at a cost exceeding $120 per dose.
Acknowledging the challenges faced by insured patients, CMS emphasized that it has been closely coordinating with insurance plans for months to ensure their systems are up-to-date and prepared to meet their obligations in providing coverage for COVID-19 vaccines.
While payers are in the process of updating their systems, CVS has assured patients that their pharmacy teams can help them schedule a vaccine appointment for a later date if their insurance coverage is initially denied.
One insured individual, Sarah Lindsey, called out her insurer, Florida Blue, on social media, urging them to add the new COVID vaccines to their coverage. Florida Blue responded by stating that the shots are covered for most beneficiaries at no cost, and any insured patient who was charged should contact their pharmacy for reimbursement or file a claim with Florida Blue.
Healthcare provider Elevance Health has also urged pharmacies to resubmit COVID vaccine claims to be processed at a no-copay cost. They expect the delays in coverage to be resolved swiftly.
With only 17% of the U.S. population receiving Pfizer’s and Moderna’s bivalent COVID boosters since their approval in September, concerns are growing that vaccine hesitancy, pandemic fatigue, and confusion surrounding personal risk levels may impede widespread uptake of the new vaccines.
As the situation unfolds, authorities are working to address the delays and ensure that all Americans can access the COVID vaccines as recommended by public health officials.