Sarah Bennett
Medicare Part B covers the administration fee for the COVID-19 vaccine, which is approximately $45 per dose. This fee is paid to the doctor or care provider and not charged to the patient. Medicare Advantage Plan members must use the card from their plan to access these services, and they may need to get the vaccine from an in-network provider. For patients who have trouble travelling to receive the vaccine, Medicare will pay a doctor or care provider to administer the vaccine in the patient's home.
| Characteristics | Values |
|---|---|
| Does Medicare Part B pay for vaccine admin fees? | Yes, Medicare Part B covers vaccine administration fees. |
| Does Medicare cover the COVID-19 vaccine? | Yes, Medicare covers the COVID-19 vaccine. |
| Does Medicare cover other vaccines? | Yes, Medicare covers other vaccines such as the flu vaccine, hepatitis B vaccine, and pneumococcal vaccine. |
| Are there any additional costs for Medicare beneficiaries? | No, Medicare beneficiaries pay nothing for the COVID-19 vaccine and its administration. However, if they receive other medical services at the same time, they may owe a copayment or deductible for those services. |
| Are there any requirements for Medicare coverage of the COVID-19 vaccine? | Medicare Advantage Plan enrollees must use their plan card and may need to receive the vaccine from an in-network provider. Those with disabilities or facing challenges in getting to a vaccination site away from home may be eligible for in-home vaccination services covered by Medicare. |
| What is the Medicare payment amount for administering the COVID-19 vaccine? | The payment amount varies and depends on factors such as facility type and geographic location. The national average for administering the COVID-19 vaccine is approximately $45 per dose, with an additional payment of $40 for in-home administration. |
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What You'll Learn
COVID-19 vaccine administration fees
COVID-19 vaccines are available at no cost to anyone living in the United States. However, professionals may charge a vaccine administration service fee to insurance providers. The Centers for Medicare & Medicaid Services (CMS) have recently announced updates and changes to these fees.
CMS guidelines allow medical providers to charge a fee to insurance companies only. Providers that receive the COVID-19 vaccine free from the federal government are prohibited from seeking reimbursement from consumers for vaccine administration costs, including through cost-sharing or balance billing. The Health and Human Services’ Office of the Inspector General asks anyone who has been fraudulently charged a fee associated with receiving a COVID-19 vaccine to report the provider requesting a fee.
For Medicare patients with Part A coverage only, ask if they have other medical insurance to cover Part B services, like vaccine administration. If so, submit your COVID-19 vaccine administration claims to the insurance company. Only bill for the additional in-home payment amount if the sole purpose of the visit is to administer a COVID-19 vaccine. Don't bill for the additional amount if you provide and bill Medicare for another service in the same home on the same date. For dates of service starting January 1, 2024, you should bill for the additional payment amount (approximately $40 in CY 2025) only once per patient per date of service in that home, even if you administer other Part B preventive vaccines (flu, hepatitis B, or pneumococcal).
For Medicaid beneficiaries who are not eligible for this coverage, professionals may submit claims for reimbursement for administering the COVID-19 vaccine to underinsured individuals. This is available through the COVID-19 Coverage Assistance Fund, administered by the Health Resources and Services Administration (HRSA). For uninsured individuals, providers may submit claims for reimbursement for administering the COVID-19 vaccine through the Provider Relief Fund, also administered by the HRSA.
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Preventative vaccine administration fees
Medicare Part B generally covers the administration fees for the aforementioned vaccines, ensuring that beneficiaries do not incur out-of-pocket expenses for vaccine administration. This coverage extends to both in-home and communal vaccination settings, with certain conditions in place.
For in-home vaccine administration, Medicare pays an additional amount per patient per date of service, regardless of whether other Part B preventive vaccines are administered during the same visit. This means that if a patient receives a COVID-19 vaccine and a flu shot during a single home visit, Medicare will cover the additional in-home payment only once, but the administration fee will be paid for each vaccine dose administered.
For communal spaces or group living locations, Medicare has specific guidelines. If fewer than 10 Medicare patients at the same group living location receive the vaccine on the same day, providers can bill for up to 5 vaccine administration services. However, if 10 or more patients are vaccinated on the same day, the maximum billable administration services are limited.
It is important to note that Medicare Advantage Plans may have different requirements. Beneficiaries with these plans might need to obtain vaccines from in-network providers to avoid potential costs. Additionally, Medicare patients with Part A coverage only may need to rely on other insurance to cover Part B services, such as vaccine administration fees.
In summary, Medicare Part B typically covers preventative vaccine administration fees for specific vaccines, with provisions in place for in-home and communal settings. However, it is always advisable to verify coverage details with Medicare and review any applicable guidelines or restrictions.
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Medicare Part B premium increases
Medicare Part B covers the administration fees for the COVID-19 vaccine. The administration fee is billed to the insurance company, and there is no fee for the vaccine itself.
The Part B premium is an individual's monthly payment for coverage. The standard Part B premium has generally increased every year since its debut in 1966, when it was $3 per month. The premium was $174.70 per month as of 2024, and the standard Part B premium increased by a little over $10/month in 2025, to $185.
The hold-harmless provision protects beneficiaries from Medicare Part B premium increases in years when the Social Security Cost of Living Adjustment (COLA) is smaller than the increase in Medicare Part B premiums. It limits the Part B premium increase to ensure that beneficiaries' Social Security checks don't decrease. In such a case, the Part B increase is limited to the amount of the COLA, meaning the full COLA is used to cover the increase, and beneficiaries receive the same Social Security amount as the previous year. This provision typically affects a small number of beneficiaries with relatively low Social Security checks.
If you fail to enroll in Medicare Part B during your seven-month enrollment period, you can enroll each succeeding year (January 1 - March 31), but your monthly premium will be increased by 10% for each year you were eligible but did not enroll. This penalty does not apply if you delayed enrollment due to having other coverage from a current employer or your spouse's employer.
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Medicare billing for vaccine administration
Medicare Part B covers the administration fee for the COVID-19 vaccine. Patients do not pay anything out-of-pocket for the vaccine and its administration. However, providers can seek reimbursement for an administration fee from a patient's healthcare plan, including Medicare.
Providers must be Medicare-enrolled to bill Medicare for administering COVID-19 vaccines to Medicare patients. They can bill on single claims for administering the COVID-19 vaccine or submit claims on a roster bill for multiple patients. When choosing the Place of Service (POS) code for Part B claims, providers should carefully consider where they provided the vaccine. Roster billers should use POS code 60, regardless of provider type.
For dates of service starting January 1, 2024, providers should bill for the additional payment amount (approximately $40 in CY 2025) only once per patient per date of service in that home, even if they administer other Part B preventive vaccines (like the flu, hepatitis B, or pneumococcal). For example, if a patient receives a COVID-19 shot and a flu shot in one home visit, only one in-home additional payment will be covered. However, the administration fee (approximately $45 for the COVID-19 vaccine in CY 2025) will still be paid for every vaccine dose administered.
For dates of service from June 8, 2021, to August 23, 2021, providers should bill for the additional payment amount of approximately $35 only once per date of service in that home, regardless of how many Medicare patients received the vaccine. Starting August 24, 2021, Medicare pays the additional payment amount (approximately $40 per dose administered for CY 2025) for up to a maximum of 5 vaccine administration services per home unit or communal space within the same group living location.
Providers must acknowledge and document their patient's self-reported qualifying conditions for additional doses for immunocompromised Medicare patients. They should also bill the appropriate billing code for administering additional, booster, or pediatric doses, consistent with the FDA's updated EUAs. When the government provides COVID-19 vaccines at no cost, providers should only bill for vaccine administration and must not include vaccine codes on the claim.
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Medicare coverage for COVID-19 vaccines
Medicare Part B covers all FDA-approved vaccines for COVID-19. This means that Medicare covers the updated (2024–2025 formula) Moderna, Pfizer-BioNTech, or Novavax COVID-19 vaccine for anyone who has Medicare. People with Medicare cannot be charged for any administration fee or any copays or coinsurance related to getting the vaccine. Medicare beneficiaries should make sure to show their red, white, and blue Medicare card or their Medicare Advantage Plan card at the time of vaccination.
If you paid a fee or got a bill for a COVID-19 vaccine, check your receipts and statements for any mistakes. Call your provider’s office to ask about any charges you think are incorrect. If you have Original Medicare, review your “Medicare Summary Notice” for errors. Report anything suspicious to Medicare by calling 1-800-MEDICARE (1-800-633-4227). If you have other coverage like a Medicare Advantage Plan, review your “Explanation of Benefits.” Report anything suspicious to your insurer. If you think your provider incorrectly charged you for the COVID-19 vaccine, ask them for a refund. If you think you were charged for an office visit or other fee, but the only service you got was a COVID-19 vaccine, report them to the Office of the Inspector General.
Before submitting a Medicare claim for administering COVID-19 vaccines, you must find out if your Medicare patients have other insurance, such as employer health insurance or coverage through a spouse’s employer health insurance. You must gather information from patients with Original Medicare and those enrolled in Medicare Advantage plans. Verify the insurance information by asking your patients Medicare Secondary Payer questions. If your patients only have Part A Medicare coverage, ask if they have other medical insurance to cover Part B services, like vaccine administration. If so, submit your COVID-19 vaccine administration claims to the insurance company.
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Frequently asked questions
Yes, Medicare Part B covers the administration fee for the COVID-19 vaccine. If you have Medicare Part B and face challenges in getting to a vaccination location, Medicare will pay for a doctor or provider to administer the vaccine in your home.
There is no cost to the patient for the COVID-19 vaccine and its administration under Medicare Part B. However, if you receive other medical services at the same time, you may owe a copayment or deductible for those additional services.
The Medicare payment amount for administering the COVID-19 vaccine varies based on facility type and geographic location. The national average for physicians, hospitals, and pharmacies to administer the vaccine is approximately $12 more for single-dose vaccines and $35 more for two-dose vaccines.
To bill for COVID-19 vaccine administration under Medicare Part B, you must gather information from patients with Original Medicare and those enrolled in Medicare Advantage Plans. You must verify the patient's insurance information and submit the claim to the appropriate insurer.
