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Philadelphia-area pediatricians and family medicine providers say new federal policies for COVID-19 vaccines are leaving some of their patients confused about their future eligibility and insurance coverage for the shots.
Federal agencies this week approved updated COVID-19 vaccines ahead of the fall season, but with limited use in adults and children — a departure from past guidance that broadly recommended shots for everyone 6 months and older.
“At this point, everyone who gets a COVID vaccine should have it paid for by their insurance or … covered by things like Medicare and Medicaid,” said Dr. Jennifer Hamilton, a family medicine practitioner. “What that’s going to be like in a month or two, I’m not as sure as I’d like to be.”
On Wednesday, the U.S. Food and Drug Administration approved revised COVID-19 vaccines for seniors 65 and older as well as younger adults and children with at least one underlying condition that increases their risk for severe infection, including asthma, obesity and lung disease.
Health care providers say they’ve been fielding calls from families and patients wondering if they’ll be able to get updated shots this season, especially if they don’t qualify by age or an underlying condition.
Hamilton, who is a fellow at the American Academy of Family Physicians, said that includes at least one of her patients, a woman who is the sole caregiver for her husband with Alzheimer’s disease.
“She’s not listed as the medically vulnerable one, but she needs to stay healthy and she wants to make sure that she can get that COVID vaccine,” she said. “And right now, I don’t have a good answer for her.”
Some health care providers might be willing to give shots to people “off label,” or if they determine that the vaccine is still safe and beneficial, even if a patient doesn’t meet the federally approved conditions.
But people are then more likely to run into health insurance issues, Hamilton said. Some programs and plans only cover vaccines based on federal recommendations.
People who get COVID-19 vaccines otherwise could end up paying as much as $141 per dose, according to Centers for Disease Control and Prevention private sector vaccine prices from last season.
That won’t be an option for many families, Hamilton said.
“Just having them at the doctor’s office doesn’t count if people can’t afford to receive the vaccines,” she said.