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April 8, 2021
We know the CARES Act provides that all insurance plans that are subject to the Affordable Care Act’s preventative services coverage standards must cover any qualifying coronavirus preventive services, including approved vaccines, without cost-sharing to the employee.
We know that the vaccine cost is covered by the government. However, we are now starting to see administration fees, which is allowed.
What is an administration fee, and how much does it cost?
Effective for COVID-19 vaccines administered on or after March 15, 2021, for federally ran vaccination sites, the national average payment rate for physicians, hospitals, pharmacies and other immunizers will be $40 for each does of a COVID-19 vaccine.
This represents an increase from approximately $28 to $40 for the administration of a single-dose vaccine, and an increase from approximately $45 to $80 for the administration of COVID-19 vaccines requiring two doses.
The exact payment rate for administration of each dose of a COVID-19 vaccine will depend on the type of entity that furnishes the service and will be geographically adjusted based on where the service is furnished.
We saw that CMS was allowed to adjust the administrative fee cost, and now we are seeing private entities that are also administering vaccines will adjust to align with the CMS coverage costs.
What plans are allowed to cost-share with participants?
It’s not very many plans, but plans that are not subject to the ACA’s preventative services coverage standards are not subject to the CARES Act and its vaccine coverage requirement.
This could be:
- Short term health
- Grandfathered plans
Individual states may ultimately require plans to cover the vaccine and waive cost-sharing, so it’s make sure to check.
However, the cost of a vaccine may be cheaper than in-patient COVID-19 care.