Medicare and the COVID-19 Vaccine

Medicare and the COVID-19 Vaccine

The Biden Administration has ensured the COVID-19 vaccine is free for everyone in America.

If you have Medicare, you will pay nothing out-of-pocket for the COVID-19 vaccine. There is no copayment, no coinsurance, and the Medicare Part B deductible does not apply.

Medicare Part B covers many preventive care services, including vaccinations to protect you from the flu and pneumonia. In addition, Medicare Part D prescription drug plans cover "all commercially available vaccines" approved by the United States Federal Drug Administration (FDA) to prevent illnesses like shingles.

Why Is the COVID-19 Vaccine Free to Medicare Beneficiaries?

The American Rescue Plan Act passed by the Biden-Harris Administration includes provisions to ensure patients are not charged for receiving the COVID shot. To accomplish this, the federal government provides the vaccines to healthcare providers free-of-cost. The Act also provides funds to cover the cost of administering the COVID-19 vaccine. The Centers for Medicare & Medicaid Services (CMS) furnishes these funds to providers servicing Medicare enrollees: $40 for single-dose vaccines and $80 for the double-dose versions. These standards are expected to remain as long as the COVID-19 pandemic is considered a public health emergency.

President Biden's goal with making the COVID vaccine free is to make it as easy as possible for people to get it. In addition to wearing a mask, washing your hands frequently, and practicing social distancing, vaccination is a vital part of slowing the spread of the coronavirus.

What If You Have Medicare Advantage?

The COVID-19 vaccination is also free to people enrolled in a Medicare Advantage plan. As with Original Medicare, CMS will pay healthcare providers' costs for administration of the COVID-19 vaccine.

Getting the COVID-19 Vaccine

The FDA has approved three different COVID-19 vaccines:

  • Johnson & Johnson Janssen
  • Moderna
  • Pfizer-BioNTech

The Johnson and Johnson Janssen COVID-19 vaccine requires only one shot. Both the Moderna and Pfizer-BioNTech COVID-19 vaccines require two shots. According to the Centers for Disease Control and Prevention (CDC), all three vaccines are safe and effective in preventing COVID-19.

As of April 2021, there are also two COVID-19 vaccines currently in their third phase of clinical trials: AstraZeneca and Novavax.

If you have not yet been vaccinated, click here to use the CDC's VaccineFinder. You can also check your local health department. If you qualify for Medicare, you are eligible to receive the vaccine. However, if you have any concerns, do not hesitate to talk to your healthcare provider.

What Are the Benefits of the COVID-19 Vaccine?

Getting the COVID-19 vaccine will help protect you from catching the coronavirus. Each option that has been approved by the FDA has proven to be highly effective in preventing the disease.

Of course, there is a slight chance you can still catch the coronavirus, even if you've been vaccinated. This is because there are different variants of the virus – just as there are of the flu. But if you've had the COVID-19 vaccine, you're less likely to become seriously ill, even if you're infected with one of the variants.

Protecting yourself from catching the coronavirus also lowers the risk to your friends and family. It's one of the most important tools we have for stopping the pandemic.

Potential Side Effects of the COVID-19 Vaccine

The most common side effects of the COVID-19 vaccine are pain, redness, and swelling at the injection point.

Additional side effects include:

  • Chills
  • Fatigue
  • Fever
  • Headache
  • Muscle pain
  • Nausea

You may experience all of the above or none of the above. Most people report slight pain in the arm where they received the injection and a general "run down" feeling for the first couple of days after receiving the shot. This is a sign that your body is working hard to build protection against the disease.

If the vaccine you receive requires two shots, side effects may be stronger after the second dose. This is normal. However, if tenderness at the injection site becomes worse after 24 hours, or if your side effects concern you, please contact your healthcare provider. You can also talk to your doctor about over-the-counter medications that can help with these symptoms, such as ibuprofen and antihistamines. The CDC does not recommend taking these medications before being vaccinated, though.

If you get the Johnson & Johnson COVID-19 vaccine, you will be fully protected after 2 weeks. Those who get either the Moderna or Pfizer-BioNTech COVID-19 vaccine are fully protected 2 weeks after receiving their second shot.

What Happens After You're Fully Vaccinated Against COVID?

Once you've been fully vaccinated, you can start to do some of the things you enjoyed before the pandemic. However, as doctors are still learning about the novel coronavirus, the CDC recommends continuing precautions like social distancing, wearing a mask, and avoiding large crowds.

Once you're fully vaccinated, you may:

  • Gather indoors with other fully vaccinated people without worrying about social distancing or wearing a mask.
  • Gather indoors with people who have not received the vaccine, without masks or social distancing, as long as no one in the group is high-risk for serious complications from COVID-19. This includes people over age 45, racial and ethnic minorities, and those with chronic medical conditions like COPD, diabetes, dementia, and cancer.
  • Travel in the United States without COVID-19 tests or self-quarantine requirements. You will, however, need to wear a mask while traveling by train, plane, or bus.

If you travel internationally, you don't have to get tested before leaving the United States (unless the country you're going to requires it). However, when it's time to return to the U.S., you will have to provide a negative test result before boarding a home-bound flight.

Can You Choose Which COVID-19 Vaccine You Get?

No, it's not likely you'll be able to choose which COVID vaccine you get due to limited availability. It's important to note that all three options have proven 100 percent effective in preventing COVID-19 hospitalization and deaths.

Additional Resources

Kolt Legette
Since 2003, Kolt Legette has helped clients navigate the often-confusing world of insurance. His number one goal is protecting the medical and financial wellbeing of every person he speaks with, whether they choose to buy insurance or not. Kolt loves representing the best brands in medical insurance as it allows him to provide side-by-side comparisons for his clients. This allows the client to decide which company works best for them. By putting the needs of the client above everything else, Kolt helps real people find affordable health insurance solutions for their most pressing healthcare needs. With his belief that peace of mind is priceless, Kolt's goal in every interaction is to make sure each person he speaks to leaves with the peace of mind they rightfully deserve.


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