Federal health officials Wednesday issued insurance coverage rules designed to deliver on the promise that every American will have access to free COVID-19 vaccines when they are approved.
The regulations from the Centers for Medicare and Medicaid Services, or CMS, will also increase what Medicare pays hospitals for COVID-19 treatments. The changes arrive at a time when coronavirus infections are rising in much of the country, signaling a third wave that could eclipse the number of cases seen earlier this year.
Congress and President Donald Trump have already enacted legislation that calls for vaccines to be free, but the new rules were needed to align that policy with the many arcane payment requirements for public and private insurance.
“CMS is acting now to remove bureaucratic barriers while ensuring that states, providers and health plans have the information and direction they need to ensure broad vaccine access and coverage for all Americans,” agency head Seema Verma said in a statement.
The rules aim to resolve potential legal issues over whether Medicare could cover a vaccine that receives “emergency use authorization” from the Food and Drug Administration. That's a step short of full approval, and questions arose about whether Medicare could pay under its standard coverage policies.
Under Wednesday's announcement:
— Seniors with traditional Medicare will pay nothing for COVID-19 vaccines, and any copays and deductibles are waived.
— The government will pay private Medicare Advantage plans to administer the vaccine to seniors. Enrollees will not be charged.
— Workplace and individual health insurance plans will cover the COVID-19 vaccine as a preventive service, with no cost sharing. The requirement applies to the vast majority of private plans, which are mandated to cover approved preventive care under the Obama-era Affordable Care Act — even as the Trump administration is trying to overturn that law at the Supreme Court.
— State Medicaid and Children's Health Insurance plans will have to provide vaccines for free for the duration of the coronavirus public health emergency.
— Doctors, clinics and hospitals vaccinating uninsured people will be able to get paid through a federal fund set up to assist health care providers under financial stress.
Coronavirus Pandemic Coverage
The regulations take effect immediately.
A White House-backed initiative called “Operation Warp Speed” seeks to have a vaccine ready for distribution in the coming months. The government is spending billions of dollars to manufacture vaccines even before they receive FDA approval, thereby cutting the timeline for delivery. Officials at the FDA have pledged that the program will not interfere with their own science-based decisions. Vaccines that do not meet the test for approval would be discarded.