The COVID-19 Vaccine: A Medicare Customer Question

Some Medicare enrollment questions come from current and future beneficiaries who are unclear about how recent developments may have altered their coverage or patient responsibility.

Here is one question that's probably on the minds of many Medicare beneficiaries as we try to put the events of the past year behind us.

The Question

I thought the COVID-19 vaccine was covered under Medicare. Why was I charged for it?

The Answer

Just as COVID-19 tests, antibody/serology tests and telehealth visits have been covered during the pandemic, the COVID-19 vaccine is covered at 100% for Medicare beneficiaries.

When your clients visit their providers to receive the vaccine, they should not be charged an office visit fee or any other fees if that was the only service performed.

However, if clients were provided with any other service during that same visit, the clients may be responsible for a copay or payment toward their deductible.

If your clients think they were billed erroneously for the vaccination, they should check their receipts and provider statements for any mistakes and contact the billing department to ask about any charges they don't understand.

If your clients have Original Medicare, they should look through their Medicare summary notice for possible errors and report anything suspicious to Medicare by calling 800-633-4227.

If clients have other coverage, such as a Medicare Advantage Plan, they should go through their explanation of benefits and contact their insurer with any questions or concerns.

After going through these steps, if a client still believes the provider incorrectly charged them for COVID-19 vaccination, request a refund. And if the client thinks the provider charged for an office visit or other fee when the only service received was the vaccine, the client also has the option to report the provider to the Office of the Inspector General, U.S. Department of Health and Human Services by calling 800-HHS-TIPS or visiting Tips.HHS.gov.

Bethany Cissell is a health care insurance services specialist at Allsup.