There’s at least one clear lesson from the COVID-19 pandemic: Vaccines work. And we also learned that vaccines are especially important for seniors, who tend to be more susceptible to a host of diseases — not just COVID-19 — than the under-65 population.
Because vaccines are considered preventive care under the Affordable Care Act, most private and employer-based health insurance covers the entire cost of vaccinations with no out-of-pocket expense for patients. Medicaid likewise will cover most or all of the cost of vaccines.
Ironically, that’s not true for most seniors on Medicare, a problem that at least one bill introduced in the U.S. House of Representatives proposes to fix.
Part B of the Medicare program primarily covers physicians’ charges. But it also pays for a few vaccines, such as the annual flu vaccine and the pneumonia vaccine, at no out-of-pocket cost to patients.
Other recommended vaccines for seniors, such as Tetanus, diphtheria and pertussis (Tdap) and, very important, the relatively new two-dose shingles vaccine, are covered under Medicare Part D’s prescription drug benefit.
But there’s a problem. Part D prescription drug plans can and often do charge patients a co-pay, which varies with the plan. Those co-pays can discourage seniors from taking the vaccine. The higher the co-pay, the higher the abandonment rate, meaning the patient will decline after hearing the co-pay cost.
The federal government is making COVID-19 vaccines free for everyone, including seniors. But imagine how many seniors, the population hardest hit by the coronavirus, would have declined the shot had they faced out-of-pocket costs.
The federal government requires that working-age people with incomes and private health coverage get their vaccines with no out-of-pocket cost, while most seniors on Medicare, who tend to live on fixed incomes and with escalating health challenges, have to fork over at least some money.
Where’s the sense in that?
First, seniors are more likely to take vaccines than younger people, in part because they are more risk averse. The U.S. Centers for Disease Control and Prevention tracks the annual flu vaccine usage. About 65% of seniors have gotten the flu vaccine in each flu season over the past decade, though nearly 70% took it in the 2019-2020 flu season. By contrast, the average for all adults age 18 and older was in the low 40% range.
Second, seniors tend to be more vulnerable, both medically and financially, than younger people. They’re the ones who need available vaccines. But with most being retired and on fixed incomes, many may feel they don’t have the extra money to pay for a vaccine, especially if a vaccine comes with a significant co-pay.
Third, most yet-to-be-developed vaccines will likely be placed under Medicare Part D rather than Part B. That’s a problem because the innovative pharmaceutical manufacturers are focusing on vaccines to address cancer, arthritis, Alzheimer’s and a host of other deadly and debilitating diseases that disproportionately affect seniors.
But don’t we want patients, including seniors, to have some skin in the game? That is, to pay something out of pocket in order to discourage overuse and abuse? With most health care, yes.
But the challenge for vaccines is underutilization, not overuse. And reducing barriers to vaccines would actually reduce total health costs.
Frankly, the federal government and the CDC have been sending confusing and at times contradictory messages about the COVID-19 vaccines. But there is no doubt or confusion about one thing: Vaccines work. And the country has relied on them to protect us from polio and many other diseases for decades.
Eliminating vaccine co-pays in Medicare Part D, as the Protecting Seniors Through Immunization Act would do, sends a strong message that the public, and especially seniors, should be taking advantage of these important medicines.