{"id":124863,"date":"2025-09-06T18:54:11","date_gmt":"2025-09-06T18:54:11","guid":{"rendered":"https:\/\/www.newsbeep.com\/ca\/124863\/"},"modified":"2025-09-06T18:54:11","modified_gmt":"2025-09-06T18:54:11","slug":"for-some-medicare-isnt-covering-the-updated-covid-vaccine-yet","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/ca\/124863\/","title":{"rendered":"For some, Medicare isn’t covering the updated Covid vaccine yet"},"content":{"rendered":"

Some older Americans on Medicare are facing an unexpected problem: The updated Covid shots \u2014 approved last month by the Food and Drug Administration for all adults 65 and up<\/a> \u2014 aren\u2019t being covered, forcing them to decide whether to pay out of pocket.<\/p>\n

Allison Engel, 74, said she visited her CVS in Pasadena, California, on Tuesday, where she was told the shot would cost $225 out of pocket.<\/p>\n

\u201cThey typed everything in, and handed me a rejection letter,\u201d Engel said. \u201cThey told me it wasn\u2019t in the Medicare system yet and I should come back in two weeks.\u201d<\/p>\n

Engel didn\u2019t want to wait, so she paid out of pocket, and hopes Medicare will reimburse her.<\/p>\n

Brant Mittler, 78, of San Antonio, said he and his wife stopped by their CVS pharmacy on Monday where they ran into the same issue.<\/p>\n

\u201cThe pharmacist tells my wife, \u2018We\u2019ve had Medicare patients coming in all day, and everybody\u2019s upset because we can\u2019t give it,\u2019\u201d he said. Mittler said they got their Covid shots Thursday after the pharmacist said Medicare had updated the system there. <\/p>\n

Their experiences are at odds with remarks from Health Secretary Robert F. Kennedy Jr., who told a Senate committee on Thursday<\/a> that most Americans are going to be able to get a Covid shot from their pharmacy for free. As HHS secretary, Kennedy oversees Medicare.<\/p>\n

Late last month, Kennedy announced that the FDA had approved updated Covid shots for the fall, but for a smaller, high-risk group: People 65 and up and those with underlying medical conditions. <\/p>\n

The limited approval raised concerns about access<\/a> for people outside the high-risk groups, but not for those eligible.<\/p>\n

\u201cAnybody can get the booster,\u201d he told members of the Senate Finance Committee, when pressed about the limited eligibility. \u201cMost Americans will be able to get it from their pharmacy.\u201d<\/p>\n

Arthur Caplan, the head of the division of medical ethics at NYU Langone Medical Center in New York City, said if eligible patients are having trouble getting the vaccine, it heightens his concerns about limited access to vaccines under shifting policies from Kennedy. <\/p>\n

\u201cMedicare should be covering the shots, but it isn\u2019t clearing people,\u201d Caplan said. \u201cSo again, this just stirs up uncertainty about, \u2018OK, am I eligible? Am I in the risk group?\u2019 People still aren\u2019t sure.\u201d<\/p>\n

The updated Covid shots began arriving at major pharmacy chains last week.<\/p>\n

But some say they\u2019re holding off in certain states<\/a> until the CDC\u2019s vaccine advisory committee issues its own recommendation on eligibility.<\/p>\n

The CDC\u2019s Advisory Committee on Immunization Practices typically meets earlier in the summer to make its Covid vaccine recommendation. This year, the group isn\u2019t scheduled to meet until Sept. 18.<\/p>\n

Medicare, however, doesn\u2019t need to wait for CDC\u2019s sign-off. Once the FDA approves a vaccine, Medicare has the authority to cover it, said Dorit Reiss, a vaccine policy expert at the University of California Law, San Francisco.<\/p>\n

CVS, one of the nation\u2019s largest pharmacy chains, said that in 13 states and Washington, D.C., everyone, including Medicare patients, will need a doctor\u2019s prescription until ACIP issues its recommendations \u2014 and even then, eligibility will depend on age. In three states \u2014 Massachusetts, Nevada and New Mexico \u2014 CVS won\u2019t be offering the Covid shot at all until ACIP acts.<\/p>\n

\u201cA few payers are still updating their systems and may not yet be set up to cover the updated Covid-19 vaccines,\u201d CVS spokesperson Amy Thibault said when asked about some Medicare patients who were told the vaccine wasn\u2019t covered. <\/p>\n

\u201cIf this happens, our pharmacy teams can help patients schedule an appointment for a later date,\u201d Thibault said.<\/p>\n

Walgreens did not respond to a request for comment. <\/p>\n

A spokesperson for the Centers for Medicare and Medicaid Services said in an emailed statement that the agency was looking into the issue.<\/p>\n

\u201cCMS continues to monitor developments related to COVID-19 vaccines,\u201d the spokesperson said. <\/p>\n","protected":false},"excerpt":{"rendered":"Some older Americans on Medicare are facing an unexpected problem: The updated Covid shots \u2014 approved last month…\n","protected":false},"author":2,"featured_media":124864,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[49,48,84,392],"class_list":{"0":"post-124863","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthcare","8":"tag-ca","9":"tag-canada","10":"tag-health","11":"tag-healthcare"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/124863","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/comments?post=124863"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/124863\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media\/124864"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media?parent=124863"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/categories?post=124863"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/tags?post=124863"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}