The COVID-19 booster is now out for the public at large to help increase your protection levels, but do Medicare benefits extend to it? You don’t want to have to pay for it out of your pocket if you can help it, and this quick guide will outline whether or not you have to based on your insurance.
Medicare Benefits and the COVID-19 Booster
Medicare will cover the COVID-19 booster shot at no additional cost to you. You can pick which vaccine you get for your booster. If you chose the Moderna or Pfizer COVID-19 vaccine and you’re 18 or older and at high risk for having severe COVID-19 or you’re 65 or older, you can get the booster six months after you get your second dose of the Moderna or Pfizer COVID-19 vaccine series. If you received the Johnson & Johnson COVID-19 vaccine and you’re 18 or older, you can get the booster two months after you get the shot.
Why Get the COVID-19 Booster
There are several reasons why you’d want to get the booster. It’s true that you might have built up enough protection against COVID-19 after your earlier vaccinations, but this protection will decrease over time against moderate or mild diseases. Also, even though the vaccines are safe and effective against protecting from severe illness or death, there isn’t a 100% effective way to prevent infection.
So, if you’re partially vaccinated or unvaccinated, it’s essential that you get the first round of shots right away to lower your risk of getting COVID-19 and the more severe outcomes.
If you’re someone who is immunocompromised, like someone who has had an organ transplant, Medicare will pay for an additional dose of the COVID-19 vaccine as long as you get it at least 23 days after you get the second dose without any cost to you. However, you shouldn’t mix the vaccines. If the first two rounds of shots you got were Pfizer, the booster should also be Pfizer. If the first two doses were Moderna, the booster should be too.
If you fill out the form to get your booster, you might get asked if your insurer has a group number. For Medicare, this wouldn’t be applicable. You can take it to the vaccine provider and ask for help if you have problems with your form. Medicare will also pay for COVID-19 tests, COVID-19 monoclonal antibody treatments, and COVID-19 antibody testing.
If You Already Paid for the COVID-19 Vaccine or Booster
When you get this vaccine, the provider won’t charge you for an office visit or another fee if you only get the vaccine at this visit and don’t have any other medical services. If you do get other medical services at the same time you get the vaccine or booster, you may have to pay your deductible or copayment. However, if you did pay a fee for just the vaccine or booster, you can check the following to see if the provider should have charged you for it:
Double-check any statements or receipts you get from the provider to look for mistakes. You can call the office and ask about any charges that you think may be incorrect. The person will either help you understand the charges or realize that there was a billing error.
For Original Medicare, you want to check your Medicare Summary Notice for any errors. You can call 1-800-MEDICARE if you find something suspicious. If you have a Medicare Advantage plan, you can double-check your Explanation of Benefits and report suspicious charges to your insurer. If you find that the provider incorrectly billed you for the COVID-19 booster or vaccine, they may issue you a refund.