By Susannah Luthi , Rachel Roubein 10/28/2020 07:16 PM EDT
The Trump administration on Wednesday released its plan for promising free Covid-19 vaccines for all Americans.
What the plan would do: The sweeping plan aims to cover the uninsured, seniors and poor Americans, as well as people with employer-sponsored or other private coverage. But the interim final rule the administration issued contains caveats.
Seniors who get coverage through Medicare won’t have to pay anything for the vaccine — although private Medicare plans may get out of having to cover the shots if the cost is significant. In that case, CMS would pay through traditional Medicare on behalf of Medicare Advantage insurers.
The policy flags an existing pot of money from Congress’ hospital bailout fund to cover vaccine costs for the uninsured. The Trump administration established this pool specifically to pay for the Covid-19 treatment for people lacking coverage. However, many eligible people haven’t taken advantage of the option since it hasn’t been broadly advertised.
Most people on Medicaid, the program for poor Americans, won’t have to pay anything for the duration of the Covid-19 public health emergency declaration, which is set to run through at least late January. Those renewals occur every three months, and once the declaration lapses, the Trump administration says that states may have to evaluate cost-sharing policies.
As expected, the rule states private health insurers will have to cover vaccines the Food and Drug Administration authorizes for emergency use as long as the Covid-19 emergency lasts, although the health officials didn’t include any check on the prices of a potential coronavirus shot — a potentially troubling issue for the health insurance industry.
The federal government has invested hundreds of millions of dollars in leading Covid-19 vaccine candidates, but so far Trump administration officials haven’t publicly discussed strategies on pricing.
In the rule however, they acknowledge that the costs may go high enough to make private Medicare plans balk. The Medicare agency said the federal government would step in and pay for private Medicare customers’ vaccines through traditional Medicare if the costs meet a “significant” amount.
Why it matters: Returning to normal life appears to hinge on vaccinating the American public. In March, Congress sought to mandate free vaccines, but under Medicare’s current rules, the program couldn’t cover the cost of drugs authorized under emergency use designations. Trump administration officials have been scrambling to come up with a fix, POLITICO reported earlier this week.
