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Technicality Jeopardizes Medicare Coverage of a COVID-19 Vaccine

Published September 30, 2020

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As it turns out, a COVID-19 vaccine may not be covered by Medicare after all. 

At least that’s the verdict from The Wall Street Journal, which on Sept. 21 pointed out a key loophole that could potentially prevent a forthcoming vaccine from being covered by Medicare, despite legislation that states otherwise.

Medicare historically only covers FDA-approved products

With speed being of the essence, there’s a likely chance that a COVID-19 vaccine would be granted Emergency Use Authorization (EUA) by the Food and Drug Administration.

An EAU designation allows the FDA Commissioner to allow unapproved medical products to be used in emergency situations (such as a global pandemic). This allows the product, in this case a vaccine, to bypass many of the steps in the approval process and be fast-tracked for release to the public.  

What's the catch? Medicare does not cover the cost of products with EUA designations. The nation’s largest health insurance provider only covers products with the standard FDA approval. 

In March, the Coronavirus Aid, Relief and Economic Security (CARES) Act was signed into law and the legislation included a guarantee of a COVID-19 vaccine being provided free of charge. According to the Wall Street Journal’s report, the White House is asking Congress to change the language in the CARES Act to account for this loophole, but concerns remain over whether that process could be completed in time. 

What COVID-19 services does Medicare cover?

Officially, Medicare can cover the following services and items related to COVID-19:

  • COVID-19 virus tests and antibody tests
  • Telehealth and other electronic appointments
  • Skilled nursing facility care
  • Long-term care hospital services
  • Inpatient rehabilitation care
  • Inpatient hospital care
  • Outpatient medical care
  • Home health services
  • Expansion of Medicare Part D drug supplies 

One additional hurdle is that the CARES Act called for a COVID-19 vaccine to be covered by Medicare Part B, which could leave some five million seniors without Medicare coverage for a vaccine. Around 56 million of the more than 61 million total Medicare beneficiaries have Part B.

Learn more about Medicare news and how the COVID-19 pandemic affects beneficiaries.