Many Hoosiers may be wondering if they will be charged for a COVID-19 vaccine. While we are under the Federal Public Health Emergency for the COVID-19 pandemic, insurance companies and plans must cover COVID-19 vaccines for free and regardless of whether the policyholder goes to an in-network or out-of-network provider. Potential violations of such requirements should be reported to the Office of Inspector General at the U.S. Department of Health and Human Services at 1-800-HHS-TIPS or TIPS.HHS.GOV.
During the Federal Public Health Emergency
During the Federal Public Health Emergency, the Families First Coronavirus Relief Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act determine whether a COVID-19 vaccine is covered by insurance plans. You should not be charged for COVID-19 vaccine administration even if your health plan does not include COVID-19 vaccination as a covered benefit or if your plan covers COVID-19 vaccine administration with cost-sharing.
Healthcare providers administering the COVID-19 vaccine should not bill consumers for the vaccine administration. Healthcare providers who administer a COVID-19 vaccine to uninsured or underinsured Hoosiers (those whose insurance plan does not require coverage of the COVID-19 vaccine) can submit claims to one of the following for reimbursement:
- Uninsured: https://www.hrsa.gov/CovidUninsuredClaim
- Underinsured: https://www.hrsa.gov/covid19-coverage-assistance
After the Federal Public Health Emergency Ends
Once the Federal Public Health Emergency comes to an end, the Affordable Care Act will determine whether the COVID-19 vaccine will be fully covered by insurance plans as a preventive service. If it is determined that it qualifies as a preventive service, then the vaccine will continue to be free of charge if you go to your in-network provider.
About the Indiana Department of Insurance
The Indiana Department of Insurance (IDOI) protects Indiana's insurance consumers by monitoring and regulating the financial strengths and market conduct activities of insurance companies and agents. The IDOI monitors insurance companies and agents for compliance with state laws to protect consumers and to offer them the best array of insurance products available. The IDOI also assists Hoosiers with insurance questions and provides guidance in understanding how insurance policies work.