Aetna, Emblem Health and UnitedHealthcare will cover cost of updated COVID-19 vaccine, insurers say
Three of the state’s largest health insurance companies said Friday they would continue to cover updated COVID-19 vaccine for members, as the impact of new federal guidelines on cost and accessibility of the shot remained unclear.
Aetna, Emblem Health and UnitedHealthcare told Newsday they would pay for fully insured members who want to receive the vaccine. Aetna and United Health Care officials said self-funded employer plans made their own decisions on coverage.
Earlier this week, Gov. Kathy Hochul urged state insurers to cover the vaccine for all New Yorkers who request it as federal officials narrow the populations it recommended for the shot.
On Aug. 27 the U.S. Food and Drug Administration authorized the updated COVID-19 vaccines for people 65 and older, along with younger people who have chronic health conditions. Previously, COVID-19 vaccines were recommended for everyone 6 months and older.
Insurance coverage of vaccines is usually linked to decisions from the U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, a panel that is not scheduled to meet until Thursday.
This left doctor’s offices and pharmacies uncertain about who they were allowed to vaccinate and if the vaccines would be covered by insurance.
"There are so many different directives from all the different agencies," said Dr. Eric Levene, a pediatrician who works with several Long Island offices of Allied Physicians Group. "There is no one clear straight path like there has been in the past with vaccines."
Infectious disease experts expressed concerns after U.S. Health and Human Services Secretary Robert F. Kennedy Jr. fired all members of the ACIP in June and replaced some with people who share his skeptical view of vaccines.
Hochul responded by signing an executive order last Friday that expands access to the vaccine in New York, saying she will "continue developing a long-term plan to fight these reckless decisions coming out of Washington, because I have no choice."
After the signing, an HHS spokesperson called the executive order "misguided and ill-conceived," and insisted anyone who wanted the vaccine cold get it after consulting with their health care provider.
The president of an organization that represents state health insurers said plans were committed to working with the state to "ensure New Yorkers have the information they need on the importance of vaccines, where and how to get immunized, and understand coverage rules."
"It is also important that immunization recommendations be informed by science that reflect the latest medical evidence, including but not limited to the Advisory Committee on Immunization Practices," said Eric Linzer, president and CEO of the New York Health Plan Association.
Levene said some patients had been asking for the vaccine while others were holding off until they were sure their insurance would cover it.
"And we are starting to see more COVID cases," he said.
Allied physicians are offering the vaccine at their offices but also asking patients to sign a form saying they will pay out of pocket if their insurance company declines to pay.
According to the CDC, the private sector cost of a dose of the adult COVID-19 vaccine costs about $140.
On its website, CVS pharmacies state the out-of-pocket cost for an updated COVID-19 vaccination could be as high as $250 in some cases.
CVS is offering the vaccine to people 65 and older, younger people with a medical condition and those with a prescription.
Lisa joined Newsday as a staff writer in 2019. She previously worked at amNewYork, the New York Daily News and the Asbury Park Press covering politics, government and general assignment.
