When the World Health Organization declared COVID-19 a pandemic in March 2020, it was hard to imagine that we would have access to FDA-approved vaccines nine months later.
Understanding how Medicare COVID-19 vaccine coverage works and how much it costs is important so you can protect yourself.
Medicare Population and COVID-19 Risk
To be eligible for Medicare, you must be 65 years or older or you must have a qualifying disability. This population is at higher risk for more severe or complicated COVID-19 infections.
Age, in and of itself, is a risk factor for severe COVID infections. The average age of COVID patients requiring care in the intensive care unit is 66 years old. People 60 years and older are at five times higher risk for dying from their infection than people 30 to 59 years old, whether or not they received care in the ICU.
The National Institute on Aging reports that 85% of senior adults have at least one chronic condition and 60% have at least two.
Data shows that certain chronic conditions, namely chronic kidney disease, chronic obstructive pulmonary disease (COPD), diabetes, heart disease, and obesity, increase the risk for serious infection or complications from COVID-19.
Long Term Care Facilities
According to the most recent data from the National Center for Health Statistics, more than 1.3 million people reside in nursing homes. As many as 83.5% of them are 65 years and older.
As of the end of May 2021, the Centers for Medicare & Medicaid Services reported approximately 132,000 COVID-related deaths in nursing home residents. This accounted for 22% of all U.S. deaths from COVID-19 at the time.
Efficacy of COVID Vaccines
To date, three COVID-19 vaccines have been deployed in the United States. A summary of their Emergency Use Authorization data is listed below:
- mRNA-based vaccine
- Two vaccine doses three weeks apart
- 42% of study participants were 55 years or older
- 18% of study participants were non-White
- 46% of study participants had chronic conditions
- 94% effective in people over 65, 95% effective overall
- mRNA-based vaccine
- Two-dose vaccine series, four weeks apart
- 23% of study participants were 65 years or older
- 21% of study participants were non-White
- 42% of study participants had chronic conditions
- 94% effective overall, 95% effective against severe disease
Johnson & Johnson (Janssen) Vaccine:
- Adenovirus-based vaccine
- A single-dose vaccine
- 35% of study participants were 60 years or older
- 38% of study participants were non-White
- 40% of study participants had chronic conditions
- 66% effective overall (72% in the United States), 85% effective against severe disease
*Effectiveness is defined as preventing symptomatic infection.
Safety of COVID Vaccines
Regardless of the vaccine type, there may be associated tenderness, redness, or swelling at the injection site. Other possible symptoms include fever, chills, headache, nausea, muscle aches, and fatigue.
While no serious side effects have yet been reported with the mRNA vaccines for older populations, the same cannot be said regarding the Johnson & Johnson vaccine. While the side effects were rare, the preliminary data showed marginal increases in thromboembolic conditions in the vaccinated group when compared to the placebo group.
By April 2021, more than 6.8 million doses had been administered to the general population. It was found that six women between 18 and 48 years old had developed cerebral venous sinus thrombosis, a rare type of stroke, within two weeks of their vaccination.
That is equivalent to 0.88 cases for every 1 million people, a rate lower than the 5 cases in 1 million per year seen in the general population. With a low overall risk from vaccination and a high risk for complications from COVID-19, the vaccine continues to be administered.
Cost of COVID Vaccines
Manufacturers invested considerable time and money into the research and development of these vaccines. While it was the moral thing to do, they did not do it for free. The federal government has purchased vaccine doses.
The Biden administration has also increased payments to healthcare providers, hospitals, and pharmacies that administer these vaccines. After all, they must properly store, prepare, and administer each dose safely and effectively.
They must also monitor people for post-vaccination reactions. This increased funding aims to give them the resources to provide this service at scale.
You, however, do not have any cost-sharing. This means there will be no copays, coinsurance, or deductibles. The vaccine will be 100% free to you during the public health emergency.
While it is true that facilities can add an “administrative fee” for your vaccination, they are not allowed to pass that cost onto you. They would only be able to charge your insurance plan, if you had one. Your insurance plan cannot then try to get you to pay for it.
If you are charged for a COVID-19 vaccine, you should reach out to the Medicare hotline at 1-800-MEDICARE. If you are on Medicare Advantage, reach out to your health plan. You may need to file a claim with your insurance company. All fees should be removed.
Fighting Vaccine Hesitancy
Some people may be hesitant about getting the vaccine. They may be uncertain about the vaccine in general, but hopefully, the data above shows that they are safe and effective.
According to USAFacts.org, almost 73% of people 65 to 74 were fully vaccinated (83% had received at least one dose), and almost 71% of people 75 and older were fully vaccinated (more than 80% had received at least one dose) by June 10, 2021.
This appears to have saved lives. In December 2020, deaths from COVID-19 in nursing home residents were as high as 6,034 per week. By the end of May 2021, those deaths were down to 116 per week, even though many areas of the country continued to have rising infection rates in their communities at the time.
The Centers for Disease Control and Prevention (CDC) also reported that seniors vaccinated with one of the mRNA vaccines were 94% less likely to be hospitalized for COVID-19.
What you should not worry about is cost. A study by TZ Insurance Solutions found that more than 320,000 Medicare beneficiaries haven’t gotten vaccinated due to concerns over expense. Do not be misled. COVID-19 vaccination is free to you no matter what.
A Word From Verywell
Medicare beneficiaries are statistically at higher risk for getting symptomatic COVID-19 infections. The vaccines currently approved for use in the United States are effective, safe, and free to you.
Protect yourself. Wear masks when you are out in public, avoid crowds, and maintain social distancing. If you haven’t already been vaccinated, you can use the vaccine finder tool courtesy of the CDC.
The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.