COVID-19 (Coronavirus): Vaccine coverage and reimbursement

December 16, 2020

Independence is committed to providing our members with access to the care they need during the COVID-19 pandemic. We encourage all Independence members and providers to visit our dedicated COVID-19 webpage regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.

Several pharmaceutical companies have developed vaccines that have shown efficacy in preventing COVID-19. Distribution of approved COVID-19 vaccines will be controlled by the U.S Government, who will collaborate with local and state governments to deliver it to providers.

There are different reimbursement rules for the vaccine and its administration, depending on whether the member has a Commercial or Medicare Advantage plan.

Commercial:

  • The vaccine will be distributed by the U.S. Government at no charge and will not be eligible for reimbursement by Independence.
  • Independence will cover the administration of approved COVID-19 vaccines as a preventive service with $0 cost-share (i.e., copayment, deductible, and coinsurance). We will reimburse the vaccine administration cost as a preventive service.

Medicare Advantage:

  • The COVID-19 vaccine has been identified as meeting Medicare's significant cost threshold. Both the vaccine and administration of the vaccine will be processed through the local Medicare Administrative Contractor (MAC) for calendar years 2020 and 2021. To find your local MAC, click here.
  • Providers must submit all claims for approved COVID-19 vaccines and associated costs to the local MAC. Claims should not be submitted to Independence.
  • Medicare Part B – not the Medicare Advantage Organization – will cover the administration of approved COVID-19 vaccines.

The procedure codes for the vaccine and administration can be found in our Commercial and Medicare Advantage Medical Policy announcements.

Learn more

For more information about Independence's position on COVID-19, please review the following resources: