Introduction to Covid Shots and Insurance Coverage
If you’re in good health and plan to get a Covid shot this fall, you might end up with an unwelcome surprise: a bill. The Food and Drug Administration is expected to approve the next round of Covid shots soon, but only for a smaller, high-risk group — adults 65 and older and people with underlying health conditions. The Centers for Disease Control and Prevention is likely to follow suit, limiting its recommendation on who should get the shots to the same groups.
The change, experts say, could affect what insurers are willing to cover for everyone else who doesn’t fall under a high-risk group.
Understanding Insurance Coverage for Covid Shots
By law, most health insurance plans are required to fully cover vaccines recommended by the CDC and its outside advisory committee, the Advisory Committee on Immunization Practices (ACIP). For those who don’t fall under the CDC’s new recommendations, experts say coverage would depend entirely on their insurance — with some deciding to fully cover the shot, others requiring a copay and some not covering it at all. Without insurance, a Covid shot can cost up to $140, according to the CDC’s vaccine price list.
Who Can Get a Covid Vaccine?
Under the expected recommendations from the CDC, healthy children and adults won’t be barred from getting the Covid vaccine, said Dorit Reiss, a vaccine policy expert at UC Law San Francisco. “It’s legal to give a vaccine off-label,” Reiss said, referring to when a doctor prescribes a drug for something different than what the FDA approved it for, “and insurance companies can choose to cover them.” A spokesperson for AHIP, a health insurance industry trade group, said that every individual insurer will come up with its own policy following the CDC’s final guidance.
Impact on Insurance Coverage and Covid Shots
The CDC’s list of conditions that put a person at high risk for severe illness from Covid is extensive, and includes cancer, heart disease and lung conditions as well as physical inactivity and depression. Insurers also take into account clinical recommendations from outside medical organizations, like the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, the spokesperson said. HHS Secretary Robert Kennedy Jr. posted a video on social media where he, along with NIH Director Jay Bhattacharya and FDA Commissioner Marty Makary, announced that the CDC would no longer recommend the COVID vaccine for healthy children and pregnant women.
Covid and Flu Shots
The changes could affect people planning to get their Covid and flu vaccines at the same time. Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Nashville, Tennessee, and an adviser to ACIP, said some people choose to get their Covid and flu shots at the same time, but there are concerns that some could be turned away due to the anticipated change in recommendations. He added that misinformation about who is able to get the Covid shots may also discourage people from getting either vaccine.
Conclusion
In conclusion, the upcoming changes in CDC recommendations for Covid shots may lead to confusion regarding insurance coverage for individuals who do not fall under the high-risk category. It is essential for individuals to understand their insurance policies and to consult with their healthcare providers to determine the best course of action for their specific situation.
FAQs
- Q: Will I have to pay for a Covid shot if I’m not in a high-risk group?
A: It depends on your insurance policy. Some insurers may fully cover the shot, while others may require a copay or not cover it at all. - Q: Can I still get a Covid vaccine if I’m not in a high-risk group?
A: Yes, you can still get a Covid vaccine, but your insurance coverage may vary. - Q: How much does a Covid shot cost without insurance?
A: A Covid shot can cost up to $140 without insurance, according to the CDC’s vaccine price list. - Q: Will the changes in CDC recommendations affect my ability to get a flu shot?
A: The changes may affect people planning to get their Covid and flu vaccines at the same time, but it should not affect your ability to get a flu shot.
