Public Health

How Much Will The COVID-19 Vaccine Cost? It May Not Be Free

Mira Research Team04 Mar 2021

Quick Digest: 

  • The FDA recently approved Moderna and Pfizer-BioNTech’s COVID-19 vaccines. Vaccine administration has already begun for health care professionals, frontline workers, and older adults.
  • As part of Operation Warp Speed, the United States placed an initial order of 100 million doses of both the Pfizer and Moderna vaccines. The Pfizer vaccine was purchased at $19.50/dose and the Moderna vaccine was purchased at approximately $32/dose.
  • Federal officials have announced that you should not expect to pay out-of-pocket when receiving the vaccine during the pandemic, even if you are uninsured. You can still be charged for the administration of the vaccine.
  • However, the COVID vaccine cost without insurance will depend on where you get vaccinated and when. Once the pandemic is over, we estimate that uninsured individuals will need to pay between $24.38 and $57.60 per dose.

The Coronavirus Vaccine is Now Available to Certain Groups in The United States

Moderna and Pfizer/BioNTech received emergency use authorization from the Food and Drug Administration (FDA) in mid-December. Both vaccines are over 94% effective in preventing COVID-19 and demonstrate no severe side effects. 

As of February 8th, more than 134 million shots have been given in the United States. Most vaccines have been given to healthcare workers, frontline workers, and individuals over the age of 65. Over the next few months, more groups will become eligible to receive the vaccine.

Dr. Anthony Fauci noted that he believes most people will not be able to get vaccinated until at least April 2021. Moderna CEO, Stephane Bancel, stated that he believes all Americans will be able to get vaccinated by June 2021. 

Whether vaccinated or not, public health officials emphasize that it is critical for people to continue to wear masks and practice social distancing to mitigate the spread of COVID-19. Read about when your state will reach herd immunity.

Learn more

The Vaccine Should be Covered by Medicare, Medicaid, and Private Insurance During the Pandemic 

Medicare: COVID-19 vaccines authorized by the FDA will be fully covered under Medicare Part B. Medicare.gov states “you pay nothing for this vaccine.”

Medicaid: If your state received additional Medicaid funding as part of the Families First Coronavirus Response Act, those with Medicaid should be able to receive the vaccine for free. However, this requirement does not necessarily extend to those who are covered by limited benefit Medicaid programs. 

After the pandemic, the cost of the vaccine for those covered by Medicaid will likely be determined by eligibility category. 

Private Health Insurance: The CARES Act requires comprehensive coverage of the COVID-19 vaccine for almost all people with private insurance. Many insurance companies, such as Blue Cross Blue Shield and Aetna, have already announced that patients will have no cost-sharing for the COVID-19 vaccine or administration. 

However, there are some exceptions. Grandfathered plans and those not regulated by the ACA, such as short-term health plans, may not fully cover the COVID-19 vaccines. 

Is The COVID Vaccine Free Without Insurance? Not Quite

The Centers for Disease Control and Prevention (CDC) states that vaccine doses bought by the U.S. government will be given to Americans at no cost. Similar to the flu shot, the CDC will be partnering with pharmacies to supply vaccines once available. 

Walgreens, CVS, Walmart, Rite Aid, Kroger, Publix, Costco, and several others have already signed up to participate in this program. 

While you will not have to pay for the cost of the vaccine, the CDC writes “vaccination providers can charge an administration fee for giving someone the shot." 

In addition, once the federal budget for COVID-19 vaccinations is exhausted, people may face out-of-pocket costs for the vaccine and its administration unless Congress can approve more funding. Below we outline how much you may need to pay for the vaccine. 

These are the estimated prices each company will charge for a COVID-19 vaccine

The price that the U.S. government pays for each COVID-19 vaccine will vary based on manufacturing costs, efficacy, demand, and use of new technologies. 

The cost will also depend on the type of vaccine. For example, mRNA-based vaccines (Moderna and Pfizer) will likely be more expensive than adenovirus vaccines (AstraZeneca).

Below is a chart of the estimated price per dosage of 5 COVID-19 vaccines in development. These prices can change depending on new deals between the U.S. federal government and vaccine manufacturers. 

Note - this is not the price that you will necessarily pay for a vaccine, but rather the estimated price per dosage that pharmaceutical companies are selling the vaccines at. 

CompanyPrice per dosage estimate
Moderna$32 to $37
Pfizer/ BioNTech$19.50
Johnson & Johnson$10
AstraZeneca$3 to $4
Novavax$16

Cost of COVID Vaccine Without Insurance Will Depend on When You Are Vaccinated 

During COVID-19 Pandemic - While Government Pays For Vaccine

According to federal health officials, vaccines purchased by the U.S. government will be available at no cost regardless of your health care or insurance status. 

Therefore, the coronavirus vaccine cost without insurance should be free while government supplies of vaccines last. 

However, you may be charged for vaccine administration and for being seen by a provider depending on where you get vaccinated.

 According to the Centers for Medicare and Medicaid Services “for a COVID-19 vaccine requiring a series of 2 or more doses, the initial dose(s) administration payment rate will be $16.94, and $28.39 for the administration of the final dose in the series.” 

Based on this data, if you do not have insurance, we predict that you may be charged a fee between around $16 - $29 for the administration of each dose of the vaccine. 

If you are charged an administration fee and you do not have insurance, The Health Resources and Services Administration’s Provider Relief Fund may be able to assist you with reimbursement. 

Nonetheless, the CDC notes that nobody can be denied vaccination for not being able to pay the administration fee. So even if you are unable to pay a fee, you should still make an appointment to get vaccinated when you are eligible. 

After the COVID-19 Pandemic - If Government No Longer Pays For the Vaccine 

When the money allocated to this fund is exhausted, people without insurance may be expected to pay the full price of the vaccine in addition to its administrative costs. 

This is why when you get the vaccine matters. If you get the vaccine when funding is still available, you will most likely only have to pay for administrative fees. However, when funding runs out, people without insurance may have to pay for the full cost of the vaccine. 

In order to account for supplies and administrative fees, The American Academy of Pediatrics (AAP) recommends that the price of vaccines should be marked up by at least 25% of the cost reported by the CDC vaccine price list for the private sector. 

At 25% above the price of $19.50/dose, the Pfizer vaccine would cost $24.38 per dose or $48.75 total. At 25% above the price of $32/dose, the Moderna vaccine would cost $40 per dose or $80 total. 

However, we found that vaccine prices can oftentimes be increased to 80% above the private sector price. For example, the CDC private sector cost for a quadrivalent flu shot is around $17 but many people need to pay at least $30 out of pocket, which is an 80% markup.  

At 80% above the private sector price, the Pfizer vaccine would cost $35.10 per dose or $70.20 total. The Moderna vaccine would cost $57.60 per dose or $115.20 total. 

Based on these calculations, we expect the vaccines produced by Moderna and Pfizer to cost somewhere between $24.38 and $57.60 per dose. 

It is expected that once the vaccine produced by AstraZeneca is approved, it will be significantly less expensive since it is not made with mRNA technology. 

How to avoid paying high prices for the COVID vaccine? 

Since the government allocated funds to cover the cost of vaccines during the pandemic, you will likely be able to avoid high fees by getting the vaccine once it is available for your group in the population rather than waiting until after the pandemic. 

In addition, be sure to call the site you plan on getting vaccinated at before getting the vaccine to see if you will need to pay an out-of-pocket cost.

If you are covered by insurance, you should contact your insurance company to determine if they will fully cover the cost of your vaccine.

Sources: 

https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html

https://www.nytimes.com/2020/12/17/opinion/covid-vaccine-big-pharma.html

https://www.cdc.gov/vaccines/adults/rec-vac/index.html

https://www.hhs.gov/about/news/2020/07/22/us-government-engages-pfizer-produce-millions-doses-covid-19-vaccine.html#:~:text=The%20vaccine%20would%20be%20available,of%20administering%20the%20vaccine.

https://www.npr.org/sections/health-shots/2020/08/06/899869278/prices-for-covid-19-vaccines-are-starting-to-come-into-focus

https://www.vaccines.gov/get-vaccinated/pay

https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html

https://wellbeing.humboldt.edu/sites/default/files/health/PublicHealth-vaccination-pricelist.pdf

https://www.ft.com/content/80f20d71-d7eb-4386-b0f2-0b19e4aed94d

https://www.npr.org/2020/10/28/928805803/how-much-will-a-coronavirus-vaccine-cost-to-americans-with-medicare-or-medicaid

https://www.healthline.com/health-news/how-much-will-you-pay-for-a-covid-19-vaccine-heres-what-we-know

https://science.sciencemag.org/content/370/6520/1022

https://investors.modernatx.com/news-releases/news-release-details/moderna-announces-supply-agreement-us-government-initial-100

https://www.cdc.gov/vaccines/imz-managers/downloads/COVID-19-Vaccination-Program-Interim_Playbook.pdf

https://khn.org/news/article/time-to-discuss-potentially-unpleasant-side-effects-of-covid-shots-scientists-say-yes/

https://www.verywellhealth.com/how-will-my-health-insurance-cover-a-covid-19-vaccine-5090168

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