Advisory - Marylanders are eligible for ‘no-cost’ COVID-19 vaccinations: To read the December 15, 2020 full news release from the Maryland Insurance Administration stating that Marylanders cannot be billed for COVID-19 vaccines, click here.
BALTIMORE via the Maryland Insurance Administration – Maryland Insurance Commissioner Kathleen A. Birrane reminds all Marylanders that they cannot be billed for COVID-19 vaccinations.
For those who are insured, all Maryland health insurance issuers must cover the administration of vaccines authorized by the FDA for the prevention of coronavirus disease 2019 without charge. The cost protections ordered by the Hogan Administration are broader than those afforded under the federal CARES Act, because they apply to all health plans that include vaccination coverage that are issued by health insurers in Maryland, not only the non-grandfathered ACA plans referenced under federal law.
“This is significant,” said Commissioner Birrane. “Even if you do not have a traditional ACA health insurance plan, in Maryland, your health insurers still cannot charge you a co-pay or any cost sharing related to COVID-19 preventive services, including vaccinations.”
On December 11, 2020, the FDA issued an emergency use authorization (EUA) for the administration of the Pfizer-BioNTech COVID-19 Vaccine to individuals 16 years of age and older. The Advisory Committee on Immunization Practices (ACIP) voted on December 12, 2020 to recommend that the Centers for Disease Control and Prevention (CDC) approve the vaccine for use in the U.S. and to add it to the vaccine schedule. CDC Director Robert Redfield endorsed the recommendation on December 13, 2020.
CMS has advised that doses of the vaccine that are purchased with U.S. taxpayer dollars will be provided at no cost. Vaccination providers are permitted to charge a fee for the administration of the vaccine. As a condition of receiving doses of the vaccine to administer, providers must agree to administer a COVID-19 vaccine regardless of an individual’s ability to pay and regardless of their coverage status, and also may not seek any reimbursement, including through balance billing, from the vaccine recipient themselves. Providers may bill a patient’s health plan for the cost of the administration and if the patient is uninsured, the provider may seek payment from the Provider Relief Fund established by HHS pursuant to the federal CARES Act.
Under the CARES Act and corresponding federal regulations, all health insurance issuers for non-grandfathered health benefit plans must cover any ACIP-recommended COVID-19 vaccine or other preventive services, including vaccine administration costs, for in-network and out-of-network providers with no consumer cost-sharing during the federal Public Health Emergency.
However, the Hogan Administration has broadened that protection for people who are insured under plans regulated by the Maryland Insurance Administration. On September 4, Commissioner Birrane renewed emergency regulations that require all health insurance carriers operating in Maryland to waive cost-sharing for vaccination under any type of health plan, including plans grandfathered under the Affordable Care Act, short term medical plans, and certain excepted benefit plans that provide coverage for vaccinations.
Marylanders are reminded that not all health insurance plans are regulated by the Maryland Insurance Administration. Some employers, especially large ones, offer self-funded health plans that are regulated by the U.S. Department of Labor. Under the Federal CARES Act, these self-funded plans are also required to cover COVID-19 vaccines with no out-of-pocket costs. Additionally, Medicare is covering the administration costs of the vaccine for Medicare enrollees, with no cost-sharing. Medicaid is also required to cover the administration costs for Medicaid beneficiaries.
For more information, visit the Maryland Insurance Administration’s COVID-19 Resource Center at https://insurance.maryland.gov/COVID-19/Pages/default.aspx. Additional information about the Federal CARES Act can be found at https://home.treasury.gov/policy-issues/cares.