The Coronavirus vaccine that will take at least a year and up to 18 months to be developed can be designated as “essential”. Such designation would make it so that health insurance companies could not charge a copay, starting a year after the classification, per a statement by the Centers for Medicare & Medicaid Services (CMS).
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It will take 18 months for the vaccine to be available to the public. A Coronavirus vaccine “does not currently exist,” per the statement. “However, current law and regulations require specific vaccines to be covered as Essential Health Benefits (EHB) without cost-sharing, and before meeting any applicable deductible, when the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) recommends them. Under current regulations, if ACIP recommends a new vaccine, plans are not required to cover the vaccine until the beginning of the plan year that is 12 months after ACIP issues the recommendation. However, plans may voluntarily choose to cover a vaccine for COVID-19, with or without cost-sharing, prior to that date.”
A spokesperson for America’s Health Insurance Plans (AHIP), an insurance industry lobby group, told Politico that companies are solely waiving copays for “testing” the COVID-19, not a treatment for it.
EHBs currently include coverage for the diagnosis and treatment for COVID-19, but the cost-sharing expenses may likely vary by plan. Some of these require authorization from the provider before the services are covered. Many health insurance companies have announced that the tests to detect the Coronavirus are covered benefits and that they will waive cost-sharing expenses that could apply to the test. Multiple states have encouraged health insurance companies to cover testing and treatment without cost-sharing, while others have announced that health plans must cover the testing and waive prior authorization requirements.
