For some, fall Covid shots may come with copays — or no coverage at all

If you are in good health and you plan to get a kick of the fall, you could end up with an unwelcome surprise: an invoice.

The Food and Drug Administration should soon approve the next series of coated plans, but only for a smaller and high -risk group – adults aged 65 and over and people with underlying health problems. Centers for Disease Control and Prevention are likely to follow, limiting their recommendation on which should obtain photos of the same groups. (The CDC currently recommends a vaccination coded for every 6 months and more.)

The change, according to experts, could affect what insurers are ready to cover for all those who do not fall under a high -risk group.

According to the law, most health insurance plans are required to fully cover the vaccines recommended by the CDC and its external advisory committee, the Consultative Committee for Vaccination Practices (ACIP).

For those who do not fall under new CDC recommendations, the experts claim that the coverage would depend entirely on their insurance – with some deciding to fully cover the blow, others requiring a copament and some do not cover it at all.

Without insurance, a covid shot can cost up to $ 140, according to the price list of CDC vaccines.

“It could very well become confusing,” said Dr. William Schaffner, an expert in infectious diseases at the Vanderbilt University Medical Center in Nashville, Tennessee, and an ACIP. That you can get a free shooting “may depend considerably on the company with which you have your insurance”.

Who can get a cocvid vaccine?

As part of the expected CDC recommendations, healthy children and adults will not be prevented from obtaining the cocovio vaccine, said Dorit Reiss, a vaccine expert at the UC Law San Francisco.

“It is legal to give an out of AMM vaccine,” said Reiss, referring when a doctor prescribes a drug for something different from what the FDA has approved it, “and insurance companies can choose to cover them.”

An AHIP spokesperson, a commercial group of the health insurance industry, said that each individual insurer would offer their own font following the final directives of the CDC.

The list of CDC conditions which put a person at high risk of serious covid disease is extended, and includes cancer, heart disease and pulmonary conditions as well as physical inactivity and depression.

Insurers also take into account clinical recommendations from external medical organizations, such as the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, the spokesperson said.

On Tuesday, the AAP, which expressed its disapproval for the vaccination decisions of the Secretary of Health, Robert F. Kennedy Jr., published his own recommendations supporting the vaccinations cocvid for children.

Most people are also unlikely to notice changes in their insurance coverage overnight – if there are any, according to the AHIP spokesperson.

For private plans – including Obamacare’s plans – any change from APIP meetings can probably only be implemented during the next year of services, generally on January 1, the spokesman said. This means that it is possible that people who have a chance before it are covered. The Medicare and Medicaid plans are required to follow the ACIP recommendations immediately after the signing of the CDC director. Covid vaccines have also already been taken into account in insurers’ plans for this year.

In a statement sent by email, a spokesperson for Blue Cross and Blue Shield said that “each independent Blue Cross and Blue Shield plan will take its own coverage decisions”.

An Aetna spokesperson said that pregnant women and children could get the new booster covers this fall and winter without copyization.

Healthy adults who get an Aetna coverage thanks to their work could have different coverage, added the spokesperson.

It is not known whether it means that they will have to pay or not.

Covid and flu

Changes could affect people who plan to get their cocvid vaccines and flu at the same time.

Schaffner, from Vanderbilt, said that some people chose to get stuck and flu at the same time, but that some could be refused due to the antipatated change in recommendations.

He added that disinformation on which is able to obtain the coated plans could also discourage people from obtaining one or the other vaccine.

“I think we have to reassure people, especially those at high risk, that the vaccine will be at their disposal,” he said.

Rick Gates, director of the Walgreens pharmacy, said his pharmacists generally determine if a patient has coverage before the administration of a vaccine.

For this reason, it is unlikely that anyone who is struck by a surprise invoice due to new CDC recommendations, he said, adding that the patient would first be informed if the vaccine is fully covered, a copyization is required or that the patient must pay completely out of his pocket.

Gates said that people were already coming for their flu vaccine, but many seem to hold the boost wearing until the updated version is available. During the seasonal peak in last year’s respiratory virus, he said, more than 50% of patients received both shots at a time-a number that has increased in the past two to three years.