HHS Reminds Insurers & Providers that COVID-19 Vaccines and Testing Must be Free for Patients

On June 9, 2021, the U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra sent a letter to insurers and providers about the cost of COVID-19 vaccinations and testing. Secretary Becerra sent the letter in response to recent reports of consumer cost concerns. The letter reminded health care providers of their signed agreements to cover COVID-19 vaccines free-of-charge to patients. The letter also reminded group health plans and health insurers of their legal requirement to provide full coverage of COVID-19 vaccines and diagnostic testing.

COVID-19 vaccines and their administration are free for any individual living in the United States, regardless of their insurance or immigration status. All health care providers administering COVID-19 vaccines are required to sign the Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Program Provider Agreement. The agreement states that providers must administer COVID-19 vaccines at no out-of-pocket cost to the patient. The agreement also states that providers may not require that patients have additional medical services to receive their COVID-19 vaccination. Providers may not charge any type of fee if COVID-19 vaccination is the sole medical service provided to the patient.

Providers can seek reimbursement through Medicare, Medicaid, private insurance, or other applicable coverage for administration of vaccines. Most group health plan and health insurers are statutorily required to cover COVID-19 vaccines recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention without cost-sharing.

For uninsured and underinsured patients, providers may bill the Health Resources and Services Administration COVID-19 Uninsured and COVID-19 Coverage Assistance Fund programs for vaccine-related fees. If providers accidentally billed and received payments from patients for COVID-19 vaccine-related fees, those payments should immediately be returned to their patients. Providers who fail to abide by CDC vaccine program requirements may be reported to the HHS Office of the Inspector General for possible enforcement action, in addition to remedies for non-compliance with the CDC Provider Agreement.

This past February, HHS with the Department of Labor and the Department of the Treasury issued updated guidance addressing the requirement that group health plans and health insurers cover COVID-19 diagnostic testing without cost-sharing. Group health plans and health insurers are also prohibited from delaying COVID-19 diagnostic testing or making COVID-19 diagnostic testing more cumbersome and costly through prior authorization or other medical management.

Health plans and health insurers failing to comply with these legal requirements may be reported to appropriate state insurance departments or to CMS for possible enforcement action.  The Department of Labor will also address any complaints regarding coverage offered in connection with private, employer-sponsored group health plans.