Federal Health Officials Warn Insurers They Must Cover Updated COVID-19 Vaccines



Courtesy of usf.edu
Following reports that some Americans were being charged for the updated COVID-19 booster vaccines, which should be free, federal health officials are reminding insurers and other payers of their “legal obligations.”
Programs and requirements outlined in the CARES Act and the Inflation Reduction Act should make the updated vaccines available to all Americans with no out-of-pocket cost, but some people are being charged more than $100 to receive updated vaccines from Moderna and Pfizer.
For those with private insurance as well as Medicare and Medicaid, plans are required by law to cover the COVID-19 vaccines at no cost through in-network providers, and to cover the vaccine out-of-network without cost sharing. For those without insurance, the Department of Health and Human Services launched the Bridge Access program at Vaccines.gov to cover vaccine costs.
In a letter to insurers and other payers dated Sept. 22, Health and Human Services Secretary Xavier Becerra brought attention to coverage denials reported by insured Americans trying to get the updated vaccine.
“Unfortunately, some consumers are experiencing insurance coverage denials when seeking the updated COVID-19 vaccines, and I am writing to ask for continued partnership and also want to remind you of legal obligations for coverage of the vaccines,” Becerra wrote.
Normally, insurers have a grace period before being required to cover new vaccines, but the COVID-19 vaccines were required to be covered immediately.
“We began preparing for this over a year ago to ensure a smooth transition for the updated COVID-19 vaccines,” Becerra stated in his letter, reminding insurers, pharmacists, and other providers that federal health officials have been warning them for months to get their systems ready.
Consumers who have been wrongly charged or denied insurance coverage for the vaccine are urged to contact their insurer to dispute the charge.
The Centers for Disease Control and Prevention recommended that everyone ages 6 months and older get an updated COVID-19 booster vaccine.
The agency warned of another possible “tripledemic” of respiratory illnesses this fall and winter, which could strain hospitals if COVID, influenza and RSV all circulate and peak at around the same time. The agency said hospitalizations due to COVID-19 have been on the rise in recent weeks, and are expected to continue rising.
TMX contributed to this article.