During these unprecedented times, Houston residents have many questions about a potential COVID vaccine and whether it will be covered by Medicare. Medicare is a national health insurance program that provides insurance for Americans 65 or older and some younger individuals with a disability. Similarly, Medicare Advantage is a type of health insurance plan that provides Medicare benefits through a private-sector health insurer, rather than the government. In Texas, over 4 million people rely on Medicare for their health needs. Because of this, it is important to know whether individuals with Medicare will have to pay out of pocket for a COVID vaccine – something many cannot afford – or whether it will be covered by Medicare. Those with questions about what Medicare covers can reach out to a Houston estate planning attorney for assistance.
Good and Bad News About The CARES Act
The CARES Act provides that if a COVID-19 vaccine becomes available, Medicare is required to cover the cost under Part B. Ordinarily, Medicare Part B helps to pay for doctor visits, preventive services, and vaccines such as the flu and pneumonia shots. Additionally, Medicare Advantage plans are required to include the basic coverage offered by Medicare Parts A and B, meaning a COVID-19 vaccine would also be covered for those with Medicare Advantage plans.
However, there is the potential that Medicare will not cover a COVID-19 vaccine: if the Food and Drug Administration passes the vaccine through an emergency use authorization, it will not be covered by Medicare unless the government passes further legislation to the contrary. The Emergency Use Authorization (EUA) authority gives the FDA the power to allow medical products to be used in an emergency to prevent life-threatening conditions without going through the regular approval process when there are no available alternatives. Authorizing a vaccine through a EUA is a faster method of approving drugs where waiting for all the evidence needed for FDA approval would cost thousands of lives, like the pandemic. However, there is no statutory provision that requires Medicare to cover the cost of vaccines approved under EUAs. This means that individuals relying on Medicare would likely need to pay for the cost of the vaccine themselves, if the vaccine is approved through the EUA.
Thus, to ensure the vaccine is covered by Medicare, the government would need to act if the vaccine is authorized through an EUA. This could be done by amending the language of the CARES Act to ensure coverage, or by passing separate legislation to this effect.
Because determining Medicare eligibility for matters as critical as a COVID vaccine is very important, those concerned about Medicare coverage should contact an experienced elder law attorney.
Are You or a Loved One In Need Of Assistance Applying for Medicare Benefits?
If you are interested in speaking to an attorney to learn more about Medicare and its limitations, or any other elder law issue, contact the Houston elder law attorneys at McCulloch & Miller, PLLC. With years of experience helping seniors and their families apply for benefits and supporting them in making long-term care and estate planning decisions, our dedicated attorneys will help your elderly loved one prepare for the future. To schedule a consultation and speak to an attorney, call us today at 713-333-8900.