ANALYSIS | If The COVID Vaccine Is Free For Patients, Who Is Paying For It?

Federal law ensures the COVID vaccine will be provided to every American at no cost. So who is paying for it?

Because it’s health care, the answer is complicated and we are all paying for it – mostly through taxes and a bit through our insurance premiums.

Let’s break it down.

What Will I Have To Pay To Get A Vaccine? 

Patients don’t have to pay anything out-of-pocket to get the vaccine. Under the federal CARES Act, signed last March, the government is providing doses to all Americans without cost, no matter their insurance status or if they have no coverage.

Under the Act, providers who administer the COVID vaccine have to promise not to deny anyone based on their ability to pay. The cost of having a provider administer the vaccine is set by the law as well and will be covered by patients’ insurers, Medicare, Medicaid, or a separate federal fund for the uninsured. Under the law, providers are not allowed to charge any out-of-pocket costs such as copays or coinsurance. They are not allowed to bill patients who haven’t yet reached their deductible. Under an Executive Order from the Governor, providers are not allowed to charge “out of network” fees if patients get the vaccine from a provider that isn’t in their insurer’s network.

There is one caveat for patients who receive the COVID vaccine during a doctor’s visit that includes care for other health problems. They can be charged for that other care as usual, but not for the vaccine or its administration.

So, Who Is Paying For All These Vaccines?

The federal government has paid six pharmaceutical companies billions of dollars to develop and manufacture the COVID vaccine. The payments are part of Operation Warp Speed, a partnership between federal agencies and private companies to accelerate the development and distribution of COVID vaccines. The prices negotiated by the federal government are similar to flu vaccine prices.

By mid-December, US taxpayers had spent $12.5 billion on Operation Warp Speed for development and hundreds of millions of vaccine doses. Since then, the Biden administration has bought more, enough to vaccinate every one of the 330 million Americans. It is unusual for the federal government to pay manufacturers directly for adult vaccines; most are paid for by reimbursing states, insurers, and providers for their purchases. This was intended to speed the delivery of the vaccine to Americans.

Unlike other developed countries with universal healthcare coverage systems, the US response to COVID had to be cobbled together among the various coverage programs, private and public providers, and a stopgap had to be created for the uninsured. The federal government directly purchasing the vaccines avoided the byzantine, varied pricing processes of the fragmented US healthcare system. Surprisingly, it seems to be working.

Reimbursing providers to administer the COVID vaccine is more complicated.

Medicare, which covered 648,000 Connecticut residents in 2019, is reimbursing providers $28.39 for a single-dose vaccine and $45.33 for a two-dose vaccine. Private insurers, who cover 2.4 million Connecticut residents, must cover administration of the vaccine as preventive care which prohibits any cost sharing under the Affordable Care Act. Medicaid, which covers 766,000 Connecticut residents, always covered vaccine administration with no cost to members. COVID vaccine administration for the 207,000 Connecticut residents who are uninsured is covered by a federal fund created by the CARES Act.

Unlike cost control and removing financial barriers for patients, the federal system of getting vaccines out to states was chaotic under the last administration.

This is costing us a lot. However, it is far less than we spent on one year of the Iraq war and about as much as we spend responding to hurricanes and fires each year. The CARES Act kept costs down and removed delays and barriers to access. Insurer costs have been capped and are far less than their increased profits when people avoided care in 2020. Taxpayers are paying a reasonable price and vaccines will get our economy back up and running.

The bottom line is that there should be no cost barrier to any American getting vaccinated and policymakers have done a good job keeping costs to taxpayers and the healthcare system reasonable.

Ellen Andrews, PhD, is the executive director of the CT Health Policy Project. Follow her on Twitter @CTHealthNotes.

The views, opinions, positions, or strategies expressed by the author are theirs alone, and do not necessarily reflect the views, opinions, or positions of CTNewsJunkie.com.