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How Much Will A Coronavirus Vaccine Cost To Americans With Medicare Or Medicaid?


The Trump administration is announcing today that it will make coronavirus vaccines available at no cost to Americans on Medicare and Medicaid, including the cost of actually getting the shots. The plan will apply to any vaccine that gets emergency authorization. Seema Verma is the head of the Centers for Medicare and Medicaid Services and joins me now to explain.


SEEMA VERMA: Well, thanks for having me.

CORNISH: How much do you think it's going to cost to vaccinate the more than 130 million or so Americans who get Medicare or Medicaid?

VERMA: Well, we know in the Medicare program, those costs that a maximum will be less than $3 billion, but that could actually represent a savings to the program. I mean, so far, we've spent over $5 billion on treating Medicare recipients for COVID-related disease. The other thing to point out is that...

CORNISH: Oh, but to come back to it, so you're saying the $3 billion will be drawn from where? Like, how will it be paid for?

VERMA: That will come from the Medicare trust fund. This is consistent with how we pay for vaccines. Congress made it very clear that they wanted Medicare beneficiaries to have access to the COVID vaccine at no cost, and so the regulations that we are putting out today make good on that promise. And the other thing...

CORNISH: And you said that that's a focus on vaccines. Are there plans to cover other kinds of treatments that might be approved under emergency authorization? I think people might be thinking of something like infusions of antibodies. That's the treatment that President Trump received and that he said should be free to Americans.

VERMA: That's a great question. And we are also taking action on that today because the president has been clear that he wants to make sure that our seniors have immediate access to these new therapeutics. And sometimes that can take, actually, years for Medicare to figure out the best way to pay for them. But we're taking early action and increasing the reimbursement for these therapeutics so that if they're provided in a hospital setting, that there's no financial barrier.

CORNISH: Is there any thought to waiving the cost sharing for those often poorer Medicare beneficiaries who contract the virus and they don't have any kind of supplemental coverage?

VERMA: Sure. So for many of our low-income beneficiaries, that's where the Medicaid program steps in. And it does cover a lot of the out-of-pocket costs for Medicare beneficiaries. Many of them have Medigap as well that will cover those out-of-pocket costs. That being said, earlier this year, CMS provided waivers so that providers can waive out-of-pocket costs for Medicare beneficiaries related to COVID-related treatments.

I also want to get back to the vaccine because you talked about providing coverage at no cost for Medicare and Medicaid, but the action today will also make sure that the vaccine is available to every American at no charge. So even those that are covered by private insurance companies and the regulations that we're putting out today make it very clear that private insurance companies have to cover the cost of the - administering the vaccine because we're already going to be paying for the actual vaccine. But they have to cover the administration costs both in network and out of network. And there can't be any surprise billing or any balance billing, and it has to be free to that covered individual. And also, for uninsured...

CORNISH: This is a good...

VERMA: ...Yeah, uninsured individuals will also be covered.

CORNISH: I just want to come back to this because it's a good reminder that the Affordable Care Act forces insurers to cover federally recommended vaccines with no out-of-pocket costs. I mean, is that a benefit that Americans would lose if the administration - the Trump administration is successful in getting the ACA struck down in the courts?

VERMA: Well, the president's been very clear on this issue that he wants to make sure that every American has access to vaccines. And even with previous laws, there was coverage for preventative-type services. So the president's made very clear when it comes to vaccines, he wants to make sure that every American has access to these vaccines at no cost. And even individuals that are uninsured - we're going to be using some of the provider relief funds so if there's somebody there that doesn't have health insurance, that those costs will be covered so that nobody's paying anything for the vaccine.

CORNISH: Hospitalizations are going up. But the CARES Act that had increased Medicare patient - payments to hospitals who had COVID-19 patients, they are not going to get that money. What are your concerns going forward?

VERMA: Well, I - we haven't made any changes. So any Medicare person that is - goes to the hospital, the hospitals are receiving a 20% bump up for any person that has COVID. So even if it's not - they're not necessarily coming in for COVID-related treatment. But if they have COVID, the hospital automatically gets a 20% increase in their reimbursement.

CORNISH: That's Seema Verma, head administrator of the Centers for Medicare and Medicaid Services.

Thank you for your time.

VERMA: My pleasure. Thanks for having me. Transcript provided by NPR, Copyright NPR.