How to make sure your insurance covers vaccination

Will my plan cover vaccination?

Depending on the type of health insurance you have, your out-of-pocket cost for the COVID-19 vaccine may vary. While plans that are regulated by the Affordable Care Act are required to fully cover the vaccine and its administration, plans not regulated by the ACA may not have the same legal obligation. Depending on the state, some health insurance plans may not have to cover the vaccine at all.

In March 2020, the federal CARES Act required that most private insurance, Medicare, and Medicaid fully cover the vaccine, with no cost to the patient. The exceptions to this rule could be healthcare plans that aren’t legally considered health insurance, such as a Healthcare Sharing Ministry Plan or other healthcare cost-sharing programs.

If your insurance was acquired through your employer or the MarketPlace, the good news is you likely will have no out-of-pocket cost for the vaccine. People who are uninsured, or don’t have sufficient coverage, also qualify to have the vaccine at no cost. Thanks to the CARES Act, the government has promised to pay providers for the cost of the vaccine and its administration for uninsured individuals.

Are all types of vaccines covered?

Currently, there are three types of COVID-19 vaccines approved in the United States for emergency use. The Johnson & Johnson / Janssen vaccine only requires one dose, while the Pfizer-BioNTech and Moderna vaccines both require two doses. For the two-dose vaccines, the second dose is administered 3-4 weeks after the first dose.

Regardless of which vaccine you prefer, they are all covered under the CARES Act, and your insurance cannot refuse a specific brand of vaccine if the COVID-19 vaccination is covered. If you do prefer to have one type of vaccine over another, pharmacies such as CVS and Walgreens offer online appointment booking that displays which vaccine they have in stock.

What about COVID-19 testing?

As COVID-19 is still classified as a national emergency, the Families First Coronavirus Response Act requires private insurance, Medicaid, and Medicare to fully cover testing for the virus. Prior authorization is not required to obtain a COVID-19 test, and patients should not have any out-of-pocket costs for the test itself or any related lab fees.

Testing is also free for the uninsured or those without minimum essential coverage. But while the test itself is free, any medical treatment after a positive test may not be fully covered.

Speak to an expert

If you are unsure whether your healthcare plan will cover COVID-19 testing, vaccination, or related treatment, speak to a licensed insurance agent. Mark Dupre at the MLD Agency is happy to help you navigate the complicated world of insurance, and act as your trusted partner.

If you are currently uninsured, let Mark help you find the best plan for you and your family, so no surprise bills come to your door for COVID-19-related care.

Don’t forget to always consult your doctor, and your insurance experts, and check reputable sources like the CDC to make sure you are making the most informed decision that is safe.