How Top Payers Are Providing COVID-19 Vaccine Coverage, Support

As the American healthcare system struggles to distribute the coronavirus vaccines to the public, major payers have demonstrated a range of ways that health insurers can be involved in this effort, including but not limited to coronavirus vaccine coverage.

By law according to the Coronavirus Aid Relief, and Economic Security (CARES) Act, health plans that comply with the Affordable Care Act must cover the COVID-19 vaccine. However, as payers announce their compliance, some are sharing other ways that they intend to support COVID-19 vaccination.

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) shared its plan for vaccine coverage both during the public health emergency and after the emergency has been lifted.

Blue Cross NC members can access the vaccine at no cost as it becomes available to them based on the state’s vaccination timeline. Members living outside of the state, however, have to abide by their current states’ vaccination timelines.

When the public health emergency is over, the payer has promised to continue covering the vaccine as a preventive care measure.

Wellmark Blue Cross and Blue Shield (Wellmark) has followed the same strategy as Blue Cross NC.

The payer is currently complying with the CARES Act, but Wellmark also promised to cover COVID-19 vaccinations as a preventive care service in accordance with the Affordable Care Act after the public health emergency lifts.

This benefit would extend to all fully-insured and Medicare supplement members. However, Wellmark’s self-funded groups will collaborate with the payer to develop their own strategies.

CareFirst BlueCross BlueShield (CareFirst) was among a slew of payers that announced their COVID-19 vaccine coverage plans in December 2020. The payer stated that it would cover the FDA-approved vaccines without any cost-sharing.

CareFirst also promised to work alongside state and local leaders to inform the public about COVID-19 vaccination.

Florida Blue likewise released its COVID-19 vaccination coverage plan in December 2020. The health plan stated that the vaccine would come at no cost to members in Florida Blue employer, individual, and Medicare Advantage health plans.

The payer noted that this vaccine coverage plan applies to the Pfizer/BioNTech vaccine as well as any vaccine that receives FDA emergency use authorization.

Cigna will offer the vaccine without any cost-sharing, whether the member receives the vaccine from an in-network or an out-of-network provider, as the CARES Act prescribes.

Many of these payer announcements included more specifics about the vaccines that are available, the processes for distribution and administration, and the advantages and risks involved in receiving the vaccine.

Although the vaccine distribution process is typically not the payers’ responsibility, some payers are closer to that process than others.

Aetna waived COVID-19 vaccine cost-sharing for commercial and Medicaid members in compliance with the CARES Act.

Meanwhile, the health plan’s parent company, CVS Health, has committed to enable access to the vaccine through its CVS Pharmacies, as part of the Department of Health and Human Services’ (HHS) partnership with chain pharmacies. The company projected that it would be able to administer 20 to 25 million shots per month in 2021.

According to the Centers for Disease Control and Prevention as of January 24, 2020, over 21,800,000 doses of the coronavirus vaccines had been administered. Nearly twice that amount of vaccines have been distributed. But only 3.2 million Americans have received both doses of the drug.

"Health insurance providers will continue to work with federal, state and local leaders to provide our expertise and resources to ensure Americans get their COVID-19 vaccines,” Matt Eyles, president and chief executive officer of America’s Health Insurance Plans (AHIP), said in October 2020.

“Health insurance providers are also lending a hand in planning and strategy, educating the public, facilitating vaccine deployment, gathering data on vaccine effectiveness, and ensuring our members get any required follow up doses.”

Since then, AHIP has launched a vaccine resource page that compiles lists of payers’ actions related to the coronavirus vaccines, frequently asked questions, and a vaccine fact sheet among other resources.