This article was written in 2021. The facts and figures are current as of then. With the lifting of many COVID-19 restrictions, we will no longer be updating the article. While much of it remains true, we encourage our readers to check with CMS and the Medicare program to get the most updated information.
As the United States continues to strive toward herd immunity in the fight against the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) has made a change to help Medicare insurance beneficiaries who are struggling to get the vaccine get access to it. This latest announcement increases payments to health care providers who administer vaccinations at the homes of beneficiaries who otherwise may be unable to get the shot. This effort comes as part of the Biden Administration’s stated goal of getting vaccines to where people can get them, making it easier than ever for Medicare insurance beneficiaries to protect themselves and their communities against COVID-19 by getting vaccinated.
All facts, quotes, and figures can be found in the original CMS press release from June 9, 2021, unless cited elsewhere.
What Issue is this Change Trying to Solve?
One of the biggest issues facing a broad and comprehensive vaccination effort, besides vaccine hesitancy, is its accessibility. Not only does there have to be enough of the COVID-19 vaccine available to supply the demand, but the infrastructure to administer the shots must be in place, too. In some areas of the country, that health care network simply isn’t in place. This can make it even harder for people who are homebound, or who struggle to leave the house, to get a COVID-19 shot.
“CMS is committed to meeting the unique needs of Medicare consumers and their communities — particularly those who are home bound or who have trouble getting to a vaccination site. That’s why we’re acting today to expand the availability of the COVID-19 vaccine to people with Medicare at home,” said CMS Administrator, Chiquita Brooks-Lasure. “We’re committed to taking action wherever barriers exist and bringing the fight against the COVID-19 pandemic to the door of older adults and other individuals covered by Medicare who still need protection.”
CMS estimates that this payment expansion will benefit as many as 1.6 million Americans age 65 or older. This announcement is part two of a two-pronged approach by CMS and the Centers for Disease Control and Prevention (CDC) to address the issue getting vaccinations into the arms of hard-to-reach Americans. The first part came in the form of a CDC advisory on provider training on how to administer the vaccines to homebound people.
What All is Changing?
While many people have received their vaccination at a retail pharmacy, doctor’s office, or mass vaccination site, for the homebound, that’s simply not an option. Instead, they need the vaccine to come to them, which can be more expensive and time-intensive for providers. The incentive announced in CMS’ latest press release combats this concern in the form of an additional payment for health care providers that administer the COVID-19 vaccination at the beneficiary’s home.
The additional payment provides an extra $35 per dose for each shot given at the beneficiary’s home. This nearly doubles the original payments of $40, bringing the total payment to $75 per dose for a shot given in the home. For a two-dose shot like the Moderna or Pfizer vaccine, this payment comes out to around $150 total to administer both shots for a single patient, up from $70 for a two-dose vaccine. CMS noted that the payment rate will be adjusted based on the location of where the service is given.
Generally speaking, the additional payment accounts for the added time needed to administer the vaccine and the window of time after the shot is given to monitor the beneficiary for reactions. It should also cover any extra costs that may be associated with the service. Medicare insurance beneficiaries should still have zero out-of-pocket costs, like copayments or coinsurances, associated with getting the COVID-19 vaccination. The same is true of anyone enrolled in Medicaid, CHIP, or a private insurance plan.
How Can I Get a Vaccine?
If you’re interested in getting a COVID-19 vaccine and taking part in the national and global effort to bring the pandemic to an end, you have plenty of options. To see the availability of vaccines near you and find a site where you can make an appointment, go to Vaccines.gov for the English version of the site or Vacunas.gov for the Spanish version. You can also go directly to the websites of most commercial pharmacies and drugs store, or call your primary care physician, who may be able to give you the shot directly in their office.
For those who are homebound, it may be a bit tougher to schedule an appointment, as not every location will offer an at-home vaccination service. That said, you could work with your primary care physician to either have them come out and vaccinate you or connect you with a service that can. Some larger hospitals and health care groups are also expanding their services to include at-home inoculations, so if you can find one in your area, they may be worth trying.
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The most important takeaway from this announcement is that there are several options for those looking to get the vaccine. Even if you’re not able to get to a place that’s administering the vaccines, things are opening up to the extent where they can now come to you. Just because you’re homebound doesn’t mean your health is valued any less. If everyone does their part by getting vaccinated, we can take another big step toward ending the pandemic.
