Insurance posing problems for Ohio patients seeking COVID-19 boosters
An updated round of COVID-19 vaccine boosters became available in September but challenges loom regarding costs and accessibility.
On Sept. 14, Ohio Department of Health Director Dr. Bruce Vanderhoff said he expected the new boosters to be available to all, regardless of health insurance coverage.
“If you have medical insurance, and that includes Medicare or Medicaid, vaccines should be covered as a preventive health service, which means you likely will have no out-of-pocket costs,” Vanderhoff said in a media release. “Those without insurance can take advantage of several programs to ensure they can continue to get free vaccines, as well.”
But despite previous assurances, some individuals seeking the latest round of COVID-19 vaccines and boosters have been challenged by insurers, according to a media release issued Monday by the Cleveland Department of Public Health.
CDPH recommends individuals do the following when making plans to get a COVID-19 vaccine or booster:
• Call their insurance company before scheduling a vaccine appointment to learn about their definition of “in-network” coverage. For example, some insurance companies may only cover the vaccine if it is administered in a doctor’s office as opposed to a pharmacy.
• Speak to friends, family and colleagues who have already received the vaccine and may have advice for their specific plan.
• Wait until insurance companies clarify their policies on the vaccine and for distribution of the vaccine to healthcare providers to improve.
• Check vaccines.gov to find a COVID-19 vaccine provider near you.
“Now that the emergency phase of the pandemic is over, unfortunately, we are reminded of the barriers patients faced navigating a complex health care system before the pandemic," Dr. David Margolius, Cleveland's director of public health, said in Monday's release.
NPR recently reported that consumers are finding some pharmacies have yet to receive supplies of the latest round of boosters, while others are discovering the terms of their insurance coverage has been murky.
Vaccine manufacturers have said supply is plentiful, but adequate distribution has failed, NPR reported Sept. 27.
Jennifer Kates, senior vice president and director of the Global Health & HIV Policy Program at the Kaiser Family Foundation, told NPR that insurers "may have missed the memo" or "have been slow to get their systems ready to make that an easy process for consumers."
Kates added that if no pharmacies within an individual's network plan have the vaccine, insurers are supposed to cover it, even if it's out of network.
Public health departments and community health centers have provided free boosters to the uninsured under the Centers for Disease Control and Prevention's Bridge Access Program. Cuyahoga County will continue its community clinics to provide shots, Cuyahoga County Board of Health Medical Director Dr. Prakash Ganesh previously told Ideastream Public Media, while Monday's media release said CDPH received a limited number of vaccines from ODH to administer to the uninsured.
The CDC also contracted CVS, Walgreens and eTrueNorth to continue providing free shots to the uninsured, ODH said in September.
ODH will also continue to offer free vaccines to eligible children, including those who are uninsured, through the federal Vaccines for Children (VFC) program, a Sept. 14 release stated.
Federal funding that provided free COVID-19 vaccines and boosters to all ended in May. The Bridge Access Program will keep COVID-19 shots free for the uninsured through 2024, according to the CDC website.
The FDA approved Pfizer and Moderna's updated vaccines and boosters on Sept. 11 and the CDC recommended the shots for everyone age 6 and up on Sept. 12.
Ohio reported a 22% decrease in COVID-19 cases over the past three weeks, according to ODH data.