If you are among the nearly 68 million Americans covered under Medicare, the federal government has provided access to the COVID-19 vaccine at no cost under the CARES Act implemented in March. The vaccine will be covered under Medicare Part B, and the annual Part B deductible will not be applied. This will be the case under Original Medicare, Medicare Advantage Plans and Medicare Cost Plans.
If you have an employer-sponsored or individual plan, in most cases, the vaccine will be covered with no additional copays or coinsurance required of the insured under Section 3203 of the CARES Act. It will fall into the category of “Preventive Services” as outlined in the Affordable Care Act (ACA) and applies to all non-grandfathered plans.
Grandfathered plans (health plans in effect prior to March 23, 2010 when the ACA was signed into law) may have some or no cost-sharing depending on the plan, however, individual states may mandate these plans to cover the full cost of the vaccine and its administration. Other health plans, like short-term and healthcare-sharing ministry plans, may not cover the costs of the COVID-19 vaccine.
If you are on Medicaid, the federal government has provided extra funding to states to cover the vaccine to Medicaid recipients, without requiring them to pay a share of cost. This will be the case as long as the public health emergency is in effect. Once it has expired, cost-sharing may be determined based on eligibility level.