The author outlines her difficulties in accessing the latest COVID-19 vaccine for her family, despite being insured. She describes the difficulties in locating a provider, even after securing appointments online, and the confusion between pharmacy and medical benefits leading to unexpected costs. The author warns that the health insurance system is lagging behind in adapting to the latest vaccine, leaving some insured individuals facing significant out-of-pocket expenses.
The Frustrating Journey of Getting COVID Vaccination Amid Systemic Hurdles
With the latest monovalent COVID vaccine recommended by the CDC for all Americans aged 6 months and older, my husband and I, emergency physicians, took the initiative to protect our family and society. However, obstacles soon arose as even a national pharmacy chain failed to provide the vaccine to my elderly mother, despite an online appointment.
During the pandemic’s early stages, Congress passed bills ensuring that both public and private insurers covered the vaccine fully. But once the emergency phase ended, this responsibility shifted to health insurance companies, and the vaccine’s cost rose.
As COVID cases surge, indicated by rising wastewater numbers, securing the new monovalent vaccine is a shared responsibility. Yet, my family hit a wall: our medical plan covered the COVID shot, but no providers were offering it. Our pharmacy benefits plan didn’t cover the vaccine, but pharmacies had it.
In such a predicament, we decided to pay out-of-pocket for the vaccine. At a staggering total cost of $573 for our two teenagers and me, even the pharmacist at CVS expressed shock. We would have ended up paying $764 if my husband hadn’t had the opportunity to get immunized for free at work.
Despite insurance coverage in theory, many face barriers to accessing the new COVID vaccine. The California Medical Association reports unexpected coverage denials due to outdated billing codes. Our experience serves as a cautionary tale: those banking on their health insurance to cover the COVID shot might face hefty out-of-pocket expenses.