OHA release – OHA is aware of some people being unexpectedly charged for COVID-19 and respiratory syncytial virus (RSV) vaccines. There are a few reasons why this might happen, and we always recommend checking with your insurer if you have questions. We understand the insurance landscape for vaccines can be confusing and frustrating, especially as we move out of the pandemic. During the public health emergency, the federal government purchased COVID-19 vaccines directly from manufacturers and distributed them at no cost to states and the public. Now that the public health emergency is over, COVID-19 vaccines have moved into the commercial market, and manufacturers are selling them directly to providers and pharmacies, as they do for other vaccines. The providers and pharmacies must then bill insurance companies to get reimbursed after they administer a vaccine to a patient. If they can’t bill insurance, they will charge the patient. The new RSV vaccine for older adults only recently entered the commercial market, and some insurance companies have not yet updated their policies to include it on their lists of covered vaccines. This has led to reports of some people being charged upwards of $300 for it. We’ve heard similar reports about COVID-19 vaccines, as well as pharmacies filing Medicare claims incorrectly, resulting in a rejection of coverage. Here is a rundown of some basic facts about coverage for COVID-19, RSV and flu vaccines. This list is accurate as of the publication date of this article, and some details may change over time as the insurance landscape continues to evolve. 2023-2024 COVID-19 vaccine for adults age 18+ – Fully covered by all Marketplace plans and most other private insurance plans at no cost to the patient anywhere the vaccine is offered. It’s best to go to an in-network provider or pharmacy, but if you can’t find one, call your insurer in advance to arrange full coverage of the vaccine at an out-of-network location. Fully covered by Medicare Part B at no cost to the patient anywhere the vaccine is offered. If using a pharmacy, confirm the pharmacy will bill Medicare Part B. Fully covered by Medicare Advantage plans at no cost to the patient at in-network providers and pharmacies. Fully covered by Oregon Health Plan (OHP/Medicaid) at no cost to the patient anywhere the vaccine is offered that also accepts OHP, which includes most retail pharmacies. Fully covered for uninsured and underinsured adults through vaccine providers participating in the CDC’s Bridge Access Program. (“Underinsured” means a person’s insurance policy covers some but not all COVID-19 vaccines costs.) Find participating vaccine providers by using the Vaccines.gov search tool and filtering by “Bridge Access Program Participant.”
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