Medicare’s Guide to COVID-19 Immunization Coverage

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When the World Health Organization declared COVID-19 a pandemic in March 2020, it was hard to imagine that we would have access to FDA-approved vaccines nine months later.

It is important to understand how Medicare COVID-19 immunization coverage works and its cost so that you can protect yourself.

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Health insurance population and risk of COVID-19

To be eligible for Medicare, you must be 65 years of age or older or you must have an eligible disability. This population is at greater risk for more serious or complicated COVID-19 infections.

Age

Age, in itself, is a risk factor for serious COVID infections. The average age of COVID patients requiring intensive care unit care is 66. People aged 60 and over are five times more likely to die from their infection than people aged 30 to 59, whether or not they have received intensive care unit care.

Chronic conditions

The National Institute on Aging reports that 85% of seniors have at least one chronic disease and 60% have at least two.

Data shows that certain chronic diseases, namely chronic kidney disease, chronic obstructive pulmonary disease (COPD), diabetes, heart disease and obesity, increase the risk of serious infection or complications from COVID-19 .

Long-term care facilities

According to the most recent data from the National Center for Health Statistics, more than 1.3 million people reside in nursing homes. No less than 83.5% of them are 65 and over.

As of the end of May 2021, the Centers for Medicare & Medicaid Services reported approximately 132,000 COVID-related deaths among nursing home residents. This represented 22% of all U.S. deaths from COVID-19 at the time.

Effectiveness of COVID vaccines

To date, three COVID-19 vaccines have been deployed in the United States. A summary of their emergency use authorization data is listed below:

Pfizer vaccine:

  • mRNA vaccine
  • Two doses of vaccine three weeks apart
  • 42% of study participants were 55 or older
  • 18% of study participants were not white
  • 46% of study participants had chronic illnesses
  • 94% effective in people over 65, 95% effective overall

Moderna vaccine:

  • mRNA vaccine
  • Series of two-dose vaccines, four weeks apart
  • 23% of study participants were 65 or older
  • 21% of study participants were not white
  • 42% of study participants suffered from chronic illnesses
  • 94% overall effectiveness, 95% effective against serious illnesses

Johnson & Johnson vaccine (Janssen):

  • Adenovirus vaccine
  • A single dose vaccine
  • 35% of study participants were 60 years or older
  • 38% of study participants were not white
  • 40% of study participants suffered from chronic illnesses
  • 66% overall effectiveness (72% in the US), 85% effective against serious illness

* Efficacy is defined as the prevention of symptomatic infection.

COVID vaccine safety

Regardless of the type of vaccine, there may be tenderness, redness or swelling associated with the injection site. Other possible symptoms include fever, chills, headache, nausea, muscle pain, and fatigue.

While no serious side effects have yet been reported with mRNA vaccines for older populations, the same cannot be said for the Johnson & Johnson vaccine. While side effects were rare, preliminary data showed marginal increases in thromboembolic conditions in the vaccinated group compared to the placebo group.

As of April 2021, more than 6.8 million doses had been administered to the general population. Six women between the ages of 18 and 48 were found to have developed cerebral venous sinus thrombosis, a rare type of stroke, within two weeks of their vaccination.

This equates to 0.88 cases per 1 million people, a rate lower than the 5 cases per 1 million per year observed in the general population. With a low overall risk of vaccination and a high risk of complications from COVID-19, the vaccine continues to be administered.

Cost of COVID vaccines

Manufacturers have invested a lot of time and money in the research and development of these vaccines. While it was the moral thing to do, they didn’t do it for free. The federal government bought doses of the vaccine.

The Biden administration has also increased payments to healthcare providers, hospitals and pharmacies that administer these vaccines. After all, they must properly store, prepare, and administer each dose in a safe and effective manner.

They should also monitor people for post-vaccination reactions. This increased funding is intended to give them the resources to provide this service on a large scale.

However, you have no cost sharing. This means that there will be no co-payment, coinsurance or deductible. The vaccine will be offered to you at 100% during the public health emergency.

Administration fees

While it is true that facilities may add an “administrative fee” for your vaccination, they are not allowed to pass this cost on to you. They could only bill your insurance plan if you had one. Your insurance plan cannot then try to charge you.

If you are billed for a COVID-19 vaccine, you should contact the Medicare hotline at 1-800-MEDICARE. If you are on Medicare Advantage, contact your health plan. You may need to file a claim with your insurance company. All charges should be waived.

Combat vaccine hesitancy

Some people may be reluctant to get the vaccine. They may be unsure about the vaccine in general, but luckily the data above shows that they are safe and effective.

According to USAFacts.org, nearly 73% of people aged 65 to 74 were fully vaccinated (83% had received at least one dose) and nearly 71% of people aged 75 and older were fully vaccinated (over 80% had received at least one dose) by June 10, 2021.

It seems to have saved lives. As of December 2020, deaths from COVID-19 among nursing home residents reached 6,034 per week. By the end of May 2021, those deaths had fallen to 116 per week, although many parts of the country continued to have rising infection rates in their communities at the time.

The Centers for Disease Control and Prevention (CDC) also reported that older people vaccinated with any of the mRNA vaccines were 94% less likely to be hospitalized for COVID-19.

What you shouldn’t worry about is the cost. A study conducted by TZ Insurance Solutions found that more than 320,000 Medicare beneficiaries have not been vaccinated due to spending issues. Make no mistake about it. The COVID-19 vaccination is free for you, no matter what.

A word from Verywell

Medicare beneficiaries are statistically more at risk of contracting symptomatic COVID-19 infections. Vaccines currently approved for use in the United States are effective, safe, and free for you.

Protect yourself. Wear masks when in public, avoid crowds, and maintain social distancing. If you haven’t been vaccinated yet, you can use the CDC’s vaccine finder.

The information in this article is current as of the date shown, which means more recent information may be available as you read this. For the most recent updates on COVID-19, visit our coronavirus news page.


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