Federal rules say that vaccines should be free. Experts, however, found loopholes which may result in surprise bills.

Unexpected costs have always been a cause for concern in the U.S. healthcare system. These include expenses for hospitalization due to complications caused by medicines and other medical devices, just like what gave rise to the Paragard Lawsuits, the legal proceedings that aim to hold a pharmaceutical company accountable for manufacturing a medical device that has negatively impacted the lives of those who bought their product.

On a completely related note, this spring, a legislation has been given green light by the congress which keeps insurers from billing patients who receive the coronavirus vaccine and applying any copayments or deductibles. The law even barred doctors, pharmacies, and hospitals from doing the same thing. 

And even though the rules all seem clear, experts still worry about unexpected costs surprising the patients, just like what happened with the COVID testing earlier this year. 

The Situation This Year

Picture of a black woman being vaccinated

Americans to be vaccinated this year and the next will not be paying for the vaccine as the federal government already made the purchase of around hundreds of millions of vaccines on the citizens’ behalf. It already bought 100 million doses of Pfizer and BioNTech’s vaccine — and there’s more to come, and another 200 million vaccines from Moderna once approved. These purchases made are enough to vaccinate 150 million Americans, considering that the vaccines require two shots.

The Affordable Care Act helps extend the benefits as it obligated most health insurers to cover all expenses for federally approved preventive care. Insurers are normally given up to two years before they start with the coverage of a newly approved service. The CARES Act, however, which was passed this spring, recommended coverage 15 days after an advice from the Advisory Committee on Immunization Practices.

Many other insurers have followed suit and have announced that the patients do not have to worry about payments for the vaccines and its administration as they will not bill them for these services. 

The federal government has also found other ways to avoid vaccine bills from piling up on people. Its offer of improved Medicaid payment rates required recipient states to fully cover the vaccines for all enrollees as a part of the deal. All 50 states heeded the call and accepted the subsidy.

The Weak Spots

Syringe with dollar sign at the bottom

The programs prepared by the federal government are indeed a big help to people — but do they really apply to everyone?

This is where experts begin to see some weak points. The first one is concerned with the

health coverage type that Americans still have up to this day. The “grandfathered” health insurance plans are still what cover millions of Americans today, and since it came even before the Affordable Care Act, it is exempted from the rules. Therefore, those insurance plans are not bound to the conditions to carry the expenses on behalf of the patients who will be injected with the coronavirus vaccine. 

Another point of worry for the experts are uninsured Americans. The country does not have a countrywide program that will cover vaccination expenses for them. So far, for the current pandemic, the United States  has instructed health providers to present expenses made for vaccinations to a Provider Relief Fund amounting to $175 billion.

As of November 10, the fund had $30 billion remaining. There is no backup plan, however, to cover the uninsured once the funds are no more. 

More Questions Come Up

Federal laws made it clear that patients need not to shoulder the costs for the vaccine and its administration. But there was no specified language as to what could be considered as “vaccine administration.”

Kao-Ping Chua, a University of Michigan assistant professor of pediatrics also expressed the same worries when he said, “The question that I’m still not clear on is what happens if someone walks into an outpatient department that charges a facility fee and gets a vaccine. Is there a possibility they could get charged? I think the answer is yes.”

Moreover, if patients suffer from the vaccine’s adverse effects in the future, they will not be free from the required medical care’s charges. If a patient’s vaccination leads into other issues, it could open the possibility for additional fees to be paid. 

As if those questions raised are not enough, just last month, there have been arguments in the Supreme Court to quash the Affordable Care Act. In case it succeeds, preventive care under its mandate like the COVID vaccine will not be covered anymore. 

Coverage of vaccine costs are all held together by the Affordable Care Act, so it could spell very big problems if it is nullified.  


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