Insurance Coverage Gap for New RSV Vaccines Leaves Patients Vulnerable

Some health insurance plans, including Medicare Part D and private prescription drug coverage, are not covering the cost of the new respiratory syncytial virus (RSV) vaccines for adults aged 60 and up. This leaves individuals responsible for paying out-of-pocket costs, which can amount to over $300. The lack of coverage is due to fragmented policies and loopholes in insurance coverage. While Medicare Part D should cover the RSV vaccines, Medicare enrollees without a Part D plan may have to pay depending on their non-Medicare prescription drug coverage. Private health insurers have used language loopholes and the absence of RSV on the CDC's annual vaccine schedule as reasons for not covering the vaccine. It is advised to check with your insurance plan before scheduling an appointment for the RSV vaccine.