As we have learned over the past year, older adults and those with severe chronic medical conditions are at a higher risk to become seriously ill if they get COVID-19. Many people with Medicare fall squarely within this population, meaning that Medicare beneficiaries are at higher risk than the general population to become seriously ill if they contract COVID-19. Therefore, it is important that Medicare beneficiaries and their caregivers are aware of Medicare’s coverage of COVID-19 testing and vaccines.
Medicare Part B covers the lab tests to detect or diagnose COVID-19. Medicare beneficiaries should have no out-of-pocket costs for these tests. This means that whether people are covered by Original Medicare or a Medicare Advantage Plan, they should not be charged copayments, deductibles, or coinsurance for COVID-19 lab tests.
Medicare Part B also covers all FDA-approved vaccines for COVID-19. Both Original Medicare and Medicare Advantage Plans cover the COVID-19 vaccines at no cost to the Medicare beneficiary. People cannot be charged for any administration fee or any copays or coinsurance related to getting the vaccine.
Medicare beneficiaries should make sure to show their red, white, and blue Medicare card or their Medicare Advantage Plan card at the time of vaccination. The medical provider or pharmacy that administers the vaccine will bill Medicare or the Medicare Advantage Plan accordingly. The vaccination provider can seek reimbursement from someone’s Medicare coverage for the administration fee.
Medicare beneficiaries can get the vaccine from any provider or pharmacy that has the vaccine. People in Medicare Advantage Plans can get the vaccine from an out-of-network provider and it should be covered at no cost to the beneficiary. COVID-19 vaccination providers cannot deny giving someone the vaccine on the basis that they are not an in-network provider with their Medicare Advantage Plan.
People cannot choose what vaccine they get when they have their vaccination appointment. Due to the limited supply of vaccines, people will get whatever vaccine the provider has available. Anyone who has questions or concerns about what vaccine they will get should call the provider ahead of time to find out what vaccine they have in stock.
People who have questions about Medicare’s coverage of COVID-19 testing or vaccines can contact APPRISE at 1-800-783-7067.
Vaccine Eligibility and Help Scheduling Vaccine Appointments
In Pennsylvania, vaccines had been distributed in four phases (i.e., 1A, 1B, 1C, and 2). We are now in Phase 2 of Pennsylvania's vaccine rollout. That means all Pennsylvanians age 16 and older are eligible to receive a COVID-19 vaccine.
People who have questions about vaccine eligibility in Pennsylvania or the vaccination process can contact the Pennsylvania Department of Health by calling 1-877-724-3258 or visiting www.health.pa.gov. To check vaccine availability, visit www.vaccinatepa.org.
People who live in Philadelphia must follow the Philadelphia Department of Public Health’s vaccine distribution guidance. Information for Philadelphia residents is available online or by calling 215-685-5488.
Older Pennsylvanians and people with disabilities can contact the PA Link to Aging and Disability Resources at 1-800-753-8827 for help scheduling vaccine appointments or finding transportation. PACE/PACENET members can contact 1-800-424-4326 for help scheduling vaccination appointments.