COVID-19: Vaccine FAQs

Aetna continues to cover any COVID-19 vaccine that has received FDA authorization (including Pfizer-BioNTech, Moderna and Johnson & Johnson (Janssen)). The pause does not affect that coverage. For so long as the Emergency Use Authorization remains in effect, Aetna will continue to cover Johnson & Johnson (Janssen) COVID-19 vaccine claims submitted at this time for members who decide with their provider that it’s the best option for them.

The CDC and FDA issued a joint statement on the Johnson & Johnson (Janssen) COVID-19 vaccine recommending a pause in the use of this vaccine out of an abundance of caution. If a provider chooses not to administer the Johnson & Johnson vaccine, providers should follow guidance from the CDC related to storage practices for COVID-19 vaccines.

No. Aetna members in Commercial and Medicaid plans will not have to pay any out-of-pocket costs for a COVID-19 vaccine. For Medicare beneficiaries, CMS will cover the full cost of the vaccine, including those in a Medicare Advantage plan.

No. Aetna members in Commercial and Medicaid plans will not have to pay any out-of-pocket costs for a COVID-19 vaccine, regardless of whether they go to an in-or out-of-network pharmacy or provider.

CMS has indicated it will pay for the cost of the vaccine for all Medicare beneficiaries. This includes, those in a Medicare Advantage plan, regardless of whether they go to an in-network or out-of-network pharmacy or provider. Please be sure to bring and show your red/white/blue Medicare ID card or your Medicare Number – not your Aetna member ID card – when you get vaccinated. This will help your health care provider or pharmacy to bill Medicare.

Members should not be charged for COVID-19 testing ordered by a provider acting within their authorized scope of care or administration of a COVID-19 vaccine. Providers can seek reimbursement for uninsured patients through the Health Resources & Services Administration (HRSA) for COVID-19 testing, treatment and vaccine administration. This information is available on the HRSA website.

Aetna will cover any COVID-19 vaccine that has received FDA authorization, at no added cost to members.

The FDA Emergency Use Authorizations for the Pfizer-BioNTech, Moderna and Johnson and Johnson (Janssen) COVID-19 vaccines have not changed.

Both the Pfizer-BioNTech and Moderna vaccines have two doses, with the second dose coming a few weeks after the first. Pfizer-BioNTech’s second dose comes three weeks after the first, and Moderna’s comes four weeks later. The second dose gives people a strong, long-lasting immunity and it is recommended that individuals get both doses of the same vaccine.

Providers will need to ensure that individuals who got the first shot receive a second shot of the right vaccine at the right time.

CMS has provided additional guidance to plans, states and providers to ensure that the statutory requirements related to COVID-19 vaccination and coverage of administration costs are implemented as Congress intended. CMS issued the payment allowances and related information below for administering COVID-19 vaccines during the Public Health Emergency. The rates apply to Medicare and Medicaid. For Commercial plans, we are seeking wherever possible to apply rates that do not exceed these CMS rates*.

COVID-19 vaccine administration reimbursement rates:

• 0001A -(Pfizer Admin): ADM SARSCOV2 30MCG/0.3ML 1ST - Rate: $40.00**^,***
• 0002A -(Pfizer Admin): ADM SARSCOV2 30MCG/0.3ML 2ND - Rate: $40.00**^,***
• 0011A - (Moderna Admin): ADM SARSCOV2 100MCG/0.5ML1ST - Rate: $40.00**^,***
• 0012A -(Moderna Admin): ADM SARSCOV2 100MCG/0.5ML2ND - Rate: $40.00**^,***
• 0021A - (AstraZeneca): ADM SARSCOV2 5X10^10VP/.5ML 1 - Rate: $40.00**
• 0022A - (AstraZeneca): ADM SARSCOV2 5X10^10VP/.5ML 2 - Rate $40.00**
• 0031A - (Janssen): ADM SARSCOV2 VAC AD26 .5ML - Rate $40.00**

Aetna updated its Market Fee Schedule on March 15, 2021 to reflect the current CMS payment allowances.

*Hospital reimbursement for Commercial plans may differ (the allowed may be higher than CMS)

**CMS indicates that their rates will also be geographically adjusted for many providers. Visit the CMS website for more information.

***Some states, such as Massachusetts, may require rates for Medicaid and Commercial plans that are higher or lower than CMS rates.

Per guidance provided by CMS, Medicare beneficiaries enrolled in MA plans will be able to access the COVID-19 vaccine, without cost sharing, at any Fee for Service provider or supplier participating in Medicare and eligible to bill under Part B for vaccine administration, including those enrolled in Medicare as a mass immunizer or a physician, non-physician practitioner, hospital, clinic or group practice. Providers should submit claims for administration of the COVID-19 vaccine to the CMS Medicare Administrative Contractor (MAC) for payment.

COVID-19 vaccinations will be available at pharmacies as well as doctors’ offices at other clinical sites of care. The list of pharmacies participating with the federal government in the administration of the vaccine can be found here. Additionally, VaccineFinder is a free, online service operated by Boston Children’s Hospital, in partnership with CDC, that has information on COVID-19 vaccine availability at certain providers and pharmacies in some states.

Our State Resource lookup tool provides links to each state’s health department and vaccine resource page, so you can get the latest information about when and where vaccines will be available in your area.

CVS Health is currently working directly with several states to support their programs to immunize eligible populations. In these locations, criteria for vaccination is determined by the state and vaccines are supplied by the state. Please visit CVS.com for the latest updates on availability at CVS locations in your area.

Twenty-one pharmacy chains, including CVS, are participating in the Federal Pharmacy Program. Aetna members are encouraged to visit the CDC website to find out which pharmacies are offering the vaccine in their state. Members should also visit the pharmacy’s website to find out if they are providing COVID-19 vaccines in their area.

As part of this program, CVS Health is now administering vaccines at 2,300 stores in 49 states, Washington D.C. and Puerto Rico. These states include Alabama, Alaska, Arkansas, Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Maryland, Michigan, Minnesota, Missouri, Mississippi, Montana, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin and Wyoming.

Eligible customers are now able to schedule an appointment on CVS.com. Please visit CVS.com frequently to check for available appointments. Customers will be able to schedule their vaccinations—both the initial shot and the second dose (if required)—at CVS.com or through the CVS app. Anyone requiring assistance with the scheduling tool or without access to a computer or mobile device is encouraged to contact CVS Customer Service.

Health care workers are defined in the federal government’s recommendations as anyone, paid or unpaid, serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials. Per guidelines from the CDC’s Advisory Committee on Immunization Practices (ACIP), health care workers are considered to be a prioritized group for vaccination and are part of Phase 1a. States may adopt different guidelines regarding prioritized healthcare workers.

Federal and state authorities are developing guidelines and processes to coordinate the distribution of COVID-19 vaccines to prioritized populations, including health care workers.

Family members of health care workers are not included in the government’s recommendation for distributing the initial supply of COVID-19 vaccines.