- The Centers for Medicare and Medicaid Services on Wednesday announced a rule change that will allow beneficiaries get a free Covid-19 vaccine if approved via emergency-use authorization.
- Without that change, Medicare only would cover a vaccine that undergoes the standard approval process for new treatments.
Medicare beneficiaries will now be able to get a free Covid-19 vaccine if one is approved early.
A rule change announced late Wednesday by the Centers for Medicare and Medicaid Services will allow full coverage for any Covid vaccine that gets approval, even if through emergency-use authorization.
The CARES Act, signed into law in March, called for no cost-sharing for Medicare beneficiaries for a Covid-19 vaccine once it's available. However, under standard Medicare rules, the legislation would apply only to a vaccine that undergoes the standard approval process for new biologics, not one that is fast-tracked.
The expectation is that the government would make the limited quantities of an early vaccine 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.
Medicare would pay $28.39 for a single-dose vaccine; if two doses were needed, the rate would be $16.94 for the first dose and $28.39 for the second.
There are about 62.7 million individuals enrolled in Medicare, although not all are enrolled in Part B, which generally covers preventative vaccines deemed necessary. (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).
If everyone on Medicare were to get vaccinated, the cost would be an estimated $2.6 billion, according to the Centers for Medicare and Medicaid Services.
Pharmaceutical companies are racing to get a vaccine approved, with several moving closer to the finish line. Pfizer, for one, expects to apply for emergency-use authorization next month.