COVID-19 vaccines are free to U.S. residents. Vaccine providers cannot refuse to administer the vaccine based on ability to pay or citizenship status. Section 3203 of the CARES Act (Public Law 116-136) requires health insurance plans, Medicaid, and Medicare to cover vaccines without cost-sharing (co-pays, out-of-network charges, deductibles, or balance billing).
Vaccine providers may charge a vaccine administration service fee. Administration fees must be clearly explained to vaccine recipients.
On March 15, the Centers for Medicare & Medicaid Services (CMS) updated the Medicare payment rates for COVID-19 vaccine administration. Effective for services furnished on or after March 15, 2021, the new Medicare payment rate for administering a COVID-19 vaccine is approximately $40 for each dose of a COVID-19 vaccine.
For COVID-19 vaccine administration services furnished before March 15, 2021, the Medicare payment rate for a single-dose vaccine or for the final dose in a series is $28.39. For a COVID-19 vaccine requiring a series of two or more doses, the payment rate is $16.94 for the initial dose(s) in the series and $29.39 for the final dose in the series.
Ohio Medicaid’s payment rates for COVID-19 vaccination administration are equal to the Medicare rates. Vaccine providers can expect that other public and private health insurance plans will reimburse at rates approximate to the CMS rates. There should be no out-of-pocket expenses to COVID-19 vaccine recipients. Patients receiving the COVID-19 vaccine during a regular office visit are still responsible for co-pays, and a vaccine administration service fee may be billed to their insurance plan, Medicaid, or Medicare.
When vaccinating the uninsured, vaccine providers should seek reimbursement of vaccine administration services fees via the Health Resources and Services Administration (HRSA). Vaccine providers should review the program requirements on the HRSA website. Enrolled vaccine providers can submit requests for reimbursement for vaccinating uninsured persons via the portal.
Grant money allocated for vaccine distribution efforts cannot be used to recover vaccine administration services fees unless specifically permissible under program guidelines. If uncertain of allowable uses, please check with the administrator of the grant program.