Will I need to pay for my COVID-19 vaccination?

You may be scrambling to schedule a COVID-19 vaccination for yourself or a loved one. But, will you be responsible for costs associated with vaccination?

Earlier What You Need to Know Now posts here and here explained that all COVID-19 testing and associated costs must be covered without cost-sharing under the Coronavirus Aid, Relief, and Economic Security (CARES) Act.

The CARES Act requires that all health plans subject to the Affordable Care Act’s preventive services coverage standards, including fully insured plans, must cover any qualifying coronavirus preventive services, including approved vaccines, without cost-sharing, such as co-payments, deductibles or co-insurance. The CARES Act also provides that Medicare plans must cover the cost of the COVID-19 vaccine and its administration, without cost-sharing. This coverage applies to both in- and out-of-network providers. If a medical visit is to receive a covered vaccine, the individual should not be responsible for any out of pocket costs. But, if the appointment or doctor’s visit includes health services unrelated to COVID-19, she may be responsible for a co-payment or other cost-sharing.

Independent of the CARES Act, New York law also requires health insurers to cover approved COVID-19 immunizations and their administration without cost-sharing. The New York law does not apply to self-insured plans.

However, not all health care plans are covered by these requirements. Plans that are not subject to the ACA’s preventive services rules – such as grandfathered plans – are not subject to the CARES Act vaccine coverage requirement. It appears that these plans can require that beneficiaries pay cost-sharing for vaccinations or can exclude recommended vaccines from coverage altogether. But, some such plans are providing coverage without cost-sharing. If you have questions about your coverage, you should check with your health plan administrator or human resources department.

Right now, these vaccination rules apply only to the Pfizer and Moderna vaccines, which have been approved for emergency use. As other vaccines are approved, these rules will apply to them as well.