For some, Medicare isn’t covering the updated Covid vaccine yet

Some older Americans on health insurance are confronted with an unexpected problem: the updated coated plans – approved last month by the Food and Drug Administration for all adults aged 65 and over – are not covered, forcing them to decide to pay their pocket.

Allison Engel, 74, said that she had visited her CVS in Pasadena, California on Tuesday, where she was told that the shot would cost $ 225 in her pocket.

“They hit everything and gave me a letter of rejection,” said Engel. “They told me that it was not yet in the Medicare system and I should come back in two weeks.”

Engel did not want to wait, so she paid for her pocket and hopes that Medicare will reimburse her.

Brant Mittler, 78, from San Antonio, said that he and his wife had stopped on their CVS pharmacy on Monday where they met the same number.

“The pharmacist said to my wife,” We had medicine patients all day, and everyone is upset because we cannot give it, “he said. Mittler said they had obtained their coups on Thursday after the pharmacist said Medicare has updated the system there.

Their experiences are in contradiction with the remarks of the Secretary of Health, Robert F. Kennedy Jr., who declared Thursday to a senatorial committee that most Americans could obtain a covid shot from their pharmacy for free. As HHS secretary, Kennedy supervises Medicare.

At the end of last month, Kennedy announced that the FDA had approved updated plans updated for the fall, but for a smaller and high-risk group: people 65 years and over and those with underlying medical conditions.

Limited approval has raised concerns about access to people outside of high -risk groups, but not for those who are eligible.

“Everyone can get the booster,” he told members of the Senate Finance Committee when he was in a hurry for limited eligibility. “Most Americans can get it from their pharmacy.”

Arthur Caplan, the chief of the Nyu Langone Medical Center medical ethics division in New York, said that if eligible patients had trouble obtaining the vaccine, this hung his concerns regarding limited access to vaccines as part of Kennedy’s lag policies.

“Medicare should cover the gunshots, but it doesn’t clean people,” said Caplan. “Again, it arouses uncertainty on:” Ok, am I eligible? ” Am I in the risk group? People are still not sure.

The updated coast shots began to arrive in large pharmacy channels last week.

But some say that they stand in certain states until the CDC vaccine advisory committee issues its own recommendation on eligibility.

The CDC advisory committee on vaccination practices generally meets earlier in summer to make its hairstyle vaccination recommendation. This year, the group should not meet until September 18.

Medicare, however, does not need to wait for the signing of the CDC. Once the FDA has approved a vaccine, Medicare has the power to cover it, said Dorit Reiss, an expert in the law of the law of the University of California, San Francisco.

CVS, one of the country’s largest pharmacy channels, said that in 13 states and Washington, DC, everyone, including drug patients, will need a doctor’s prescription until the AIPI makes its recommendations – and even, eligibility will depend on age. In three states – Massachusetts, Nevada and New Mexico – CVS will not offer the shot at all, until the Aipic acts.

“A few payers always update their systems and cannot yet be set up to cover updated COVVI-19 updated vaccines,” said CVS spokesperson Amy Thibault when asked for medication patients who were informed that the vaccine was not covered.

“If this happens, our pharmacy teams can help patients make an appointment for a later date,” said Thibault.

Walgreens did not respond to a request for comments.

A spokesperson for the Centers for Medicare and Medicaid Services said in a statement sent by e-mail that the agency examined the problem.

“The CMS continues to monitor developments related to COVVI-19 vaccines,” said the spokesperson.