Technicality Jeopardizes Medicare Coverage of a COVID-19 Vaccine

• by Christian Worstell
• September 30, 2020

Published September 30, 2020

Follow our Medicare Coronavirus News page for related information on coronavirus (COVID-19) and its impact on Medicare beneficiaries.

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.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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