BALTIMORE –The Maryland Insurance Administration (MIA) would like to remind consumers that they cannot be billed for COVID-19 vaccinations, including booster shots for those who meet the eligibility requirements described below.
On October 21, 2021, the Director of the Centers for Disease Control and Prevention endorsed the CDC Advisory Committee on Immunization Practices’ (ACIP) recommendation for a booster shot of COVID-19 vaccines in certain populations. For individuals who received a Pfizer-BioNTech or Moderna COVID-19 vaccine, the following groups are eligible for a booster shot at 6 months or more after their initial series:
- 65 years and older;
- Age 18+ who live in long-term care settings;
- Age 18+ who have underlying medical conditions;
- Age 18+ who work or live in high-risk settings.
For individuals who received the Johnson & Johnson COVID-19 vaccine, booster shots are also recommended for those who are 18 and older and who were vaccinated two or more months ago.
Eligible individuals may choose any of the three authorized vaccines described above for their booster dose, regardless of which vaccine type they originally received. CDC’s recommendations now allow for mix and match dosing for booster shots.
For additional information on eligibility for a booster shot, please refer to the CDC Statement on Booster Recommendations.
Under the CARES Act and corresponding federal regulations, all health insurance issuers for non-grandfathered health benefit plans must cover any ACIP-recommended COVID-19 vaccine or other preventive services, including vaccine administration costs, for in-network and out-of-network providers with no consumer cost-sharing during the federal Public Health Emergency. Under federal law, most consumers covered under Medicare, Medicaid, CHIP, and employer self-funded plans not regulated by the MIA will also be eligible for coverage of COVID-19 vaccinations with no consumer cost-sharing. This includes coverage for booster shots for those eligible as described above.
While the federal government is providing doses of the vaccine to eligible health care providers free of charge, vaccination providers are permitted to charge a fee for the administration of the vaccine. However, vaccination providers may not seek any reimbursement, including through balance billing, from the vaccine recipient themselves. Providers may bill a patient’s health plan for the cost of the administration and if the patient is uninsured, the provider may seek payment from the Provider Relief Fund established by HHS pursuant to the federal CARES Act.
About the Maryland Insurance Administration
The Maryland Insurance Administration is an independent State agency charged with regulating Maryland’s $28.5 billion insurance industry. For more information about the Insurance Administration, please visit www.insurance.maryland.gov or follow us on Facebook at www.facebook.com/MDInsuranceAdmin, Twitter at @MD_Insurance, LinkedIn at www.linkedin.com/company/maryland-insurance-administration or Instagram at @marylandinsuranceadmin.
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