Will I Have to Pay for the COVID-19 Vaccine?

Since the global pandemic began, the development of an effective COVID-19 vaccine has been an area of paramount focus. As the coronavirus vaccine makes its way to clinics and distribution sites across the country and throughout California, you may wonder how you will get yours. You might also not know whether you’ll have to pay for it and, if so, how much it will cost you.

We’ll answer those questions and more below so you’re equipped with the information you need for peace of mind and prepared to get vaccinated against the coronavirus.  

Will My Insurance Cover a COVID-19 Vaccine?

If you have an insurance plan, it will likely cover the cost of the COVID-19 vaccine. Let’s look in more detail at how Medicare, Medicaid and private health insurance plans will cover the cost of the coronavirus vaccine for their members.

Medicare Plans

According to the Coronavirus Aid, Relief and Economic Security (CARES) Act Section 3713, seniors with Medicare coverage can rest assured their COVID-19 vaccine will be provided with no sharing costs. In other words, if you have Medicare, you won’t have to pay a copay, deductible or any other out-of-pocket costs to receive the COVID-19 vaccine. Traditional Medicare plans, Medicare Advantage plans and Medicare cost plans will all cover the coronavirus vaccine at no cost to beneficiaries.

This news is especially beneficial for older adults since they are at an increased risk of being hospitalized and experiencing severe complications from COVID-19. More than 11% of Californians receive Medicare health coverage, and the 65 and older population is already eligible to be vaccinated under Phase 1B of the vaccine rollout. 

Medicaid Plans

Medicaid is funded jointly by the federal government and by states, which are responsible for administering the coverage. California’s Medicaid program, which covers a quarter of Californians, is known as Medi-Cal. Medi-Cal beneficiaries, as well as Medicaid beneficiaries in other states, will receive the COVID-19 vaccination at no cost. 

The CARES Act provides additional federal Medicaid funding to states during the public health emergency. States are eligible to receive this funding if they comply with certain criteria. One of those requirements is covering COVID-19 testing, vaccines and treatment for Medicaid beneficiaries without cost-sharing. So, if you’re a Medicaid recipient, you won’t have to pay anything — no copay, administration fee or otherwise — to get vaccinated against the coronavirus.

Private Plans

Most Americans and most Californians have private health insurance policies. Employer-sponsored group policies are the most common form of health coverage. The CARES Act specifies that private health insurance issuers offering group or individual policies must cover COVID-19 vaccines with no cost-sharing. You won’t have to pay any fees of any kind to receive the vaccine. You also aren’t required to go to an in-network provider to get your vaccine covered. 

This requirement to cover the COVID-19 vaccine applies to all health insurance plans that comply with the Affordable Care Act (ACA) since it calls for cost-free preventive care. The requirement does not extend to grandfathered health insurance plans, which predate the ACA. A minority of employees have grandfathered employer-sponsored plans. 

The requirement also does not extend to other types of plans that are not required to be ACA-compliant. Those include short-term plans, Farm Bureau plans, fixed-indemnity plans and health care sharing ministries. Even though these plans aren’t required to cover coronavirus vaccinations, some carriers may choose to do so, especially since the vaccine could help their policyholders stay healthy. 

Can I Get the COVID-19 Vaccine Without Insurance?

If you’re part of the nearly 8% of Californians that are uninsured, you may worry that lack of insurance will create a barrier to getting the vaccine. A lack of insurance can make affordable health care inaccessible in many instances. Fortunately, that is not the case when it comes to the COVID-19 vaccine. Because the virus is considered a public health crisis, special measures have been put in place to ensure all people can get the vaccine.

When you go to get your vaccine administered, the provider will likely ask to see your insurance card. If you do not have insurance, simply let the provider know. An insurance card is not a requirement for getting the vaccine. If you have insurance, you should offer this information so the vaccine provider can submit a claim to your insurance company to request payment. 

If you don’t have insurance, the provider will still administer your vaccine and should not request any form of payment. Instead, they will submit a claim to the U.S. Department of Health and Human Services (HHS) Provider Relief Fund. The HHS is distributing a total of $178 billion to health care providers to help with the coronavirus response. 

The federal government already paid for the vaccines. But there are other costs involved with getting Americans vaccinated, such as overhead costs of storing and administering the vaccine and keeping records. If you don’t have insurance, the Provider Relief Fund should cover these COVID-19 vaccine costs for providers so you don’t have to. 

How Much Is the Coronavirus Vaccine?

If you’re still wondering if the COVID-19 vaccine is free, the answer — for right now — is yes. Anyone living in the U.S. should be able to receive their coronavirus vaccine when it becomes available to them without having to pay any out-of-pocket expenses. 

Of course, this does not mean the vaccine is without cost. It just means Americans won’t have to pay for their own coronavirus vaccines. So who is paying for the COVID-19 vaccines? The main answer is the U.S. government. Before the vaccine was even available for distribution, the federal government spent more than $10 billion to aid in speedy COVID-19 vaccine development through Operation Warp Speed. 

The federal government also paid for the vaccine doses. When it comes to the costs associated with administering the vaccine, government funding is covering those fees, as well, for anyone:

• With a public health insurance plan
• Without insurance coverage
• With an insurance plan that is not ACA-compliant and does not cover the vaccine

ACA-compliant private health insurance plans will cover these administration costs for their policyholders. 

While the government currently covers the cost of the COVID-19 vaccine, this may not remain the case once the virus is no longer considered a public health emergency. Since the pandemic is constantly evolving, it’s difficult to predict precisely how long people living in the U.S. will be able to get the COVID-19 vaccine free of cost. 

Once the crisis subsides and COVID-19 vaccines are considered routine preventive care, like the flu vaccine, they’ll likely be governed by the same regulations as other routine immunizations. This classification could mean ACA-compliant health insurance policies will still be required to cover the vaccine’s cost. These policyholders may be the only ones that can count on free COVID-19 vaccines after the public health emergency ends. At that point, people without insurance may have to pay for their vaccine out-of-pocket. 

Why Is Access to the Vaccine Limited?

While there is no cost barrier to receiving the vaccine, this doesn’t necessarily mean you can walk up to your local clinic and get vaccinated right away. States are determining which groups are eligible to receive the vaccine and distributing it in stages due to the limited supply.

Two companies are currently manufacturing authorized coronavirus vaccines — Pfizer and Moderna. These companies are at full manufacturing capacity and, combined, are maintaining a weekly output of 12 million to 18 million doses. Johnson & Johnson has also manufactured a vaccine, and California is expecting to distribute that option by mid-March 2021.

Those weekly dose numbers might sound like a lot, but it’s not enough to meet the demand for the vaccine. This limited output is expected to continue into 2021. The doses go to the federal government, which is responsible for distributing them to the states. The federal government maintains a small reserve of vaccines, but this reserve is for emergency purposes and will remain in place for the time being. 

It is up to state governments to determine how they will distribute the vaccine to their residents. The Centers for Disease Control and Prevention (CDC), a federal agency, has provided recommendations to state and local governments for which populations should receive priority in vaccine distribution. These are merely recommendations, however, so states are free to approach distribution as they see fit to best serve their residents. 

The more limited the vaccine’s supply, the more selective states must be in who is eligible to receive doses. Specific criteria ensure those who need the vaccine most can get it. California is adopting the CDC’s three-phased approach to vaccine distribution with some tweaks to who is included in each phase. For example, the CDC recommends that Phase 1B of vaccination includes adults ages 75 and above, but California’s Phase 1B includes adults ages 65 and up.

As the supply of the vaccine increases and the most at-risk populations have received their vaccinations, California and other states will move into later phases of their distribution plan. They’ll allow lower-risk individuals to get vaccinated until everyone has the option of receiving the vaccine. As of the end of February 2021, over 8 million Californians have received a COVID-19 vaccine — approximately one-fifth of the state population. 

How Can I Get My COVID-19 Vaccine?

If you’re a Californian who wants to get vaccinated against COVID-19, there are a few steps you need to take to get your vaccine. None of these steps should involve any cost to you.

1. Check to See if the Vaccine Is Available for You

The vaccine is being released in phases, with each phase including additional people who are eligible to receive the vaccine. Find out which phase of the vaccine rollout California is currently in and who is included in that phase. If you are included in the current phase or a previous phase due to your age, occupation or other risk factors, you are eligible to get the vaccine.

2. Schedule Your Vaccination Appointment

There are a few ways Californians can schedule an appointment to receive their COVID-19 vaccine. One is to use the myturn.ca.gov site or call California’s COVID-19 Hotline at (833) 422-4255. You can also check to see if your local health jurisdiction has its own portal for accessing appointment scheduling. 

Another way is to contact a local provider that is administering COVID-19 vaccines directly to schedule an appointment. You can use the CDC’s VaccineFinder tool to locate a vaccination site near you. Vaccination sites may be health care facilities like hospitals, clinics and pharmacies, or they may be community facilities. 

Keep in mind that you may not be able to get an appointment right away as the demand for vaccines is extremely high. Be wary of scams that ask for a fee to secure your appointment, get you onto a waitlist or give you early access to the vaccine. No legitimate method of scheduling vaccine appointments will involve this sort of expense.

3. Get Your Second Dose of the Vaccine

Both the Pfizer and Moderna vaccines require two doses for maximum protection against the virus. The second Pfizer dose should ideally be received three weeks after the first dose, and the second Moderna dose should ideally be received four weeks after the first. While these are considered the ideal intervals between doses, you can get your second one of either vaccine up to six weeks after your first.

The key is to make sure you are receiving the same vaccine type both times. In other words, if you receive the Moderna vaccine for your first dose, your second must also be the Moderna vaccine. Bring your vaccine record and a photo ID with you to your second appointment to confirm your identity, ensure you get the correct vaccine and have your medical record updated. 

Find a Health Insurance Plan Through Health for California

The government’s commitment to cover the cost of coronavirus-related health care is limited to preventive care. You can receive the COVID-19 vaccine for free, even if you’re uninsured. But you shouldn’t expect the federal or state government to cover hospitalization or other treatment costs that result from contracting COVID-19 or from experiencing other health problems. Making sure you have adequate health insurance coverage — through private policies, Medicare, Medicaid or even short-term plans — is an important step in planning for a healthy future. 

If you’re a Californian in need of health insurance for yourself or your family, the Health for California Insurance Center can help you find the best plan for your needs. Through our website, you can easily compare plans to find a policy in your budget that will offer the coverage you want. Our online application process is a convenient way to apply for health insurance in California. Learn more about California health insurance plans so you can make an informed decision.