COVID-19: Vaccine FAQs

The FDA and the CDC are confident that the vaccine is safe and effective at preventing COVID-19. At this time, the available data suggests that the chance of developing a rare blood disorder – thrombosis with thrombocytopenia syndrome (TTS) – is very low, and the benefits of the vaccine outweigh the risks.

For women between the ages of 18 and 49, this adverse event is rare, occurring at a rate of about 7 per 1 million vaccinated women. For women 50 years and older and men of all ages, this adverse event is even more rare. Women younger than 50 should be aware that other COVID-19 vaccines are available where this risk has not been seen.

Patients who receive the Janssen vaccine should monitor for severe headache, abdominal pain, leg pain or shortness of breath for 2 weeks after administration.

If experiencing symptoms, patients should contact their health care provider.

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 can 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.

For Commercial plan members, providers should submit claims for administering the COVID-19 vaccine to an Aetna member, and associated billing codes, to Aetna for payment. However, it is not necessary for providers to submit claims, or an associated billing code, for the COVID-19 vaccine itself to Aetna.

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 in 50 states, Washington D.C. and Puerto Rico.

Customers 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.

Aetna will follow the guidance provided by the CDC and FDA regarding the age of eligibility to receive the vaccine.

As of May 12, 2021, children over the age of 12 are eligible to receive the Pfizer BioNTech vaccine.

We expect adolescents over age 12 should be able to receive a Pfizer BioNTech vaccine through many of the vaccination locations already providing vaccines today, including pharmacies, health systems, and local vaccination clinics and events. Vaccine distribution strategies vary by state, so we encourage you to check your state’s vaccine website for more information. 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 where Pfizer BioNTech vaccines are available in your area.

All children ages 12 – 15 are now eligible to receive the Pfizer BioNTech vaccine at CVS Pharmacy, provided there is parental or legal guardian consent and the child is accompanied by an adult. Because the Pfizer BioNTech vaccine is currently the only authorized vaccine for children in this age group, it is recommended to make an appointment online at CVS.com at a nearby location that has Pfizer to ensure there is adequate supply and availability. The CVS online scheduling tool will only display appointments at locations that have the Pfizer BioNTech vaccine once the patient’s age is provided.