The vaccine rollout has offered many people new hope for COVID-19 relief. With more people receiving their phone call to be vaccinated, many might be wondering who is paying for these vaccines.
There are three vaccines that providers are currently administrating across the nation: the mRNA vaccines, Pfizer-BioNTech and Moderna, and one viral vector vaccine, Janssen (or Johnson & Johnson). These are the only three approved for use so far from the Food and Drug Administration (FDA).
On March 15th, the Centers for Medicare & Medicaid Services (CMS) announced the vaccine’s Medicare payment would increase from approximately $28 to $40 for single doses and $45 to $80 for double doses. After analyzing the extent of the resources it takes to administer the vaccine, the cost changes occurred. Different vaccine providers in the industry should know how this payment affects them, so let’s break it down.
Plain and simple, Medicare patients will not have to pay a dime for their vaccine. No deductible-meeting, copayments, or coinsurance.
Medicare Advantage (MA)
Patients enrolled in MA plans will also receive their vaccine for free. Medicare will pay respective providers directly for all related administration costs for calendar years (CYs) 2020 and 2021. MA plans themselves are not required to pay providers to perform the vaccination.
Patients enrolled in Medicaid have access to the vaccine during the public health emergency (PHE) and up to one year after it is over through state Medicaid agencies and the Children’s Health Insurance Program (CHIP).
Private Insurance Plans
The majority of private insurance plans will cover the expenses of the COVID-19 vaccine under the PHE, in- or out-of-network.
The reimbursement opportunities are the primary way for providers to receive payment for uninsured patients that come in for a vaccine through the Provider Relief Fund. Patients enrolled in private insurance plans or are uninsured will have the opportunity to receive the COVID vaccine for free.
Leveraging Lightbeam to Target Eligible Patients
Lightbeam’s Cohort Builder technology is one of the greatest assets value-based care providers can have to segment a patient population and schedule those eligible for their vaccine. Whether by age, risk, or chronic condition, care coordinators can leverage the unique tool to streamline care management, address care gaps, identify opportunities for intervention, and more.
Providers can also use Lightbeam facesheets to target those who need their vaccine. The patient facesheet, available via a provider’s laptop, tablet, or printed out, has the patient’s entire health record in one place at the time of their appointment.
To learn more about Lightbeam’s industry-leading solutions, thought leadership, client success, and more, visit the Lightbeam Education Center.
Josh Patten is Lightbeam’s VP of Operations.