MDS Alert

Published on Fri Dec 04, 2020 PDF

Question: Now that several COVID-19 vaccines are closer to approval and distribution, will Medicare and Medicaid beneficiaries be covered, in terms of cost?

Florida Subscriber

Answer: Probably, at least currently. On Nov. 6, the Centers for Medicare & Medicaid Services (CMS) published an interim final rule with comment period (IFC) in the Federal Register, covering an amalgam of coronavirus updates. This is the fourth COVID-19 inspired IFC that CMS has issued and follows through on CARES Act mandates originally outlined in March.

Back in March, Congress tried to ensure under the CARES Act that everyone would be able to get the COVID-19 vaccine for free. “However, certain hurdles” prevented “Medicare and Medicaid beneficiaries from receiving the vaccine cost-free,” reminds Wachler & Associates in the firm’s Health Law Blog. Past rules didn’t allow CMS “to cover the cost of drugs authorized through emergency use protocols” — that’s one of the primary reasons the agency released this latest IFC, Wachler says.

At the time of this article’s publication, the IFC ensures that beneficiaries will have cost-free access to Food and Drug Administration (FDA)-approved vaccines when they are available.

“The IFC establishes that COVID-19 vaccines that are authorized or approved by the FDA will be covered by Medicare Part B without co-pays or deductible,” says attorney Kyle Gotchy with King & Spalding LLC in online guidance. “The IFC also implements CARES Act provisions that require most private health plans to cover a COVID-19 vaccine without cost-sharing requirements.”