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question everything

(48,811 posts)
Fri Jun 4, 2021, 01:24 PM Jun 2021

I was curious who paid for the vaccination

Since I did not see any entry in my insurance account (nor in my spouse's)

Medicare, for us, seniors.

I got mine through a "lottery" offered by a clinic associated with a hospital and I got it at a large warehouse that was fitted for this purpose. I had an appointment which I selected online, did not have to wait or stand in line, drove only 15 miles.

This claim was describes as:

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavi (0001A). And then the same but ending (0002A).

This provider charged $35 and Medicare paid $17.01 for the first dose. The second was charged $82, and Medicare paid $40.01. I have no idea why such a difference.

Spouse got them in the hospital after a clinic visit. The hospital and the clinics are all connected, also to the insurance company. Spouse was already 75 so did not have to rely on a lottery or availability at a site 300 miles away.

That claim was described as:

ADM SARSCOV2 30 MCG/0.3 ML 1ST (0001A) and then the same but ending 2ND (0002A). Here the provider charged $31.00 and Medicare paid $16.34. The second dose the charge was the same: $31.00 and Medicare paid $26.88.

I wonder why the difference.

5 replies = new reply since forum marked as read
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I was curious who paid for the vaccination (Original Post) question everything Jun 2021 OP
the feds are paying..... getagrip_already Jun 2021 #1
I always pay for my vaccinations. Chainfire Jun 2021 #2
It's supposed to be free for recipients. The government is footing the bill. brush Jun 2021 #3
Between my first and second shot Medicare raised the allowable payment. Yonnie3 Jun 2021 #4
Interesting. I got my second dose March 19, just as they raised payment. question everything Jun 2021 #5

getagrip_already

(17,436 posts)
1. the feds are paying.....
Fri Jun 4, 2021, 01:29 PM
Jun 2021

If you have health insurance, the pharmacy or dr.'s office can bill an admin fee, but you wouldn't see that either.

It is (supposed to be) completely free to those who get the shot.

 

Chainfire

(17,757 posts)
2. I always pay for my vaccinations.
Fri Jun 4, 2021, 01:31 PM
Jun 2021

But now that I am retired, I could use a little help with my planned trip to Disney World this Summer.

I really don't know who paid for my vaccination. I took it at a County operated site and assumed that the Federal G'ment footed the bill.

Yonnie3

(18,114 posts)
4. Between my first and second shot Medicare raised the allowable payment.
Fri Jun 4, 2021, 02:00 PM
Jun 2021

$17.01 for the first and 39.93 for the second was paid to CVS.

$28.39 and 56.99 were the billed amounts.

These fees were for the administration of the vaccine only because the vaccine was supplied to CVS by the government.

Straight from CMS.gov

https://www.cms.gov/medicare/covid-19/medicare-covid-19-vaccine-shot-payment

Medicare COVID-19 Vaccine Shot Payment

On March 15, 2021, CMS updated the Medicare payment rates for COVID-19 vaccine administration. Effective for services furnished on or after March 15, 2021, the new Medicare payment rate for administering a COVID-19 vaccine is approximately $40 to administer each dose of a COVID-19 vaccine. This means that starting on March 15, 2021, for single dose COVID-19 vaccines, Medicare pays approximately $40 for its administration. Starting on March 15, 2021, for COVID-19 vaccines requiring multiple doses, Medicare pays approximately $40 for each dose in the series. This rate reflects updated information about the costs involved in administering the COVID-19 vaccine for different types of providers and suppliers, and the additional resources necessary to ensure the vaccine is administered safely and appropriately. The rate is geographically adjusted based on where the service is furnished.

While CMS generally implements changes to Medicare payment rates for specific services through notice and comment rulemaking, the payment rate changes for these specific services were implemented to respond quickly to new information during the COVID-19 public health emergency.

For COVID-19 vaccine administration services furnished before March 15, 2021, the Medicare payment rate for a single-dose vaccine or for the final dose in a series is $28.39. For a COVID-19 vaccine requiring a series of two or more doses, the payment rate is $16.94 for the initial dose(s) in the series and $28.39 for the final dose in the series. These rates are also geographically adjusted.

Note: these rates do not apply for entities that are paid for preventive vaccines and their administration at reasonable cost, such as Federally Qualified Health Centers, Rural Health Clinics, and Hospital-Based Renal Dialysis Facilities. We also note that, as indicated in the 2021 Medicare Physician Fee Schedule Final Rule, CMS continues to seek additional information from the public for our further consideration as we review and establish payment rates for vaccine administration services during the public health emergency and on a longer term basis.

question everything

(48,811 posts)
5. Interesting. I got my second dose March 19, just as they raised payment.
Sat Jun 5, 2021, 12:20 AM
Jun 2021

Spouse got both before Feb 24 - before the open heart surgery.

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