Medicare will continue to provide access to vaccinations “without cost sharing” after PHE ends.
• States must provide Medicaid and CHIP coverage without cost sharing for COVID-19 vaccinations through September 30, 2024. After that date, many Medicaid and CHIP enrollees will continue to have coverage for COVID-19 vaccinations as a result of the American Rescue Plan Act (ARPA). In states that have opted to amend their policies, Medicaid coverage for the uninsured may continue beyond September 30, 2024. As per federal law, Medicaid coverage of COVID-19 vaccinations, testing, and treatment for this group will end when the PHE ends.
• Private Health Insurers will continue to offer cost-free coverage for COVID-19 immunizations administered by in-network providers. Patients who choose to receive vaccines from an out-of-network provider might have to cover a portion of the cost.
• CMS states that they will continue to pay approximately $40 per dose for administering vaccines “in most outpatient settings through the end of the calendar year in which the Secretary ends the EUA declaration for drugs and biologicals with respect to COVID-19. The EUA declaration is distinct from, and not dependent on, the PHE for COVID-19.”(1) Medicare will also pay $40 per dose or booster for multi-dose vaccinations (1).
• “Effective January 1 of the year following the year in which the EUA declaration ends, payments for administering COVID-19 vaccines will align to rates associated with preventive vaccines, which is approximately $30 per dose”(1).
• For Vaccines administered in a patient’s home for certain Medicare patients, CMS will pay approximately $36 in addition to the standard administration fee of $40 per dose, including multi-dose vaccines and booster vaccinations. Geographical adjustments will also be paid but rates are contingent upon where services are administered. Starting January 1, 2023, CMS annually updates “the additional in-home payment rate for administering the COVID-19 vaccine to reflect changes in costs related to administering preventive vaccines.” (1) The $76 total payment for in-home vaccination will continue through 2023 and will not be affected by the end of PHE