Written by L. M. Land
On September 11, 2023 many rejoiced as the U.S. Food and Drug Administration (FDA) approved the new COVID vaccine which targets the XBB.1.5 variants. This is the group of mutations currently making its way around the world.
On September 12, on a vote of 13-1, The Center for Disease Control and Prevention (CDC) also approved the vaccines made by Pfizer, BioNTech and Moderna. Novavax is still in approval process.
The FDA approved the Pfizer/BioNTech and Moderna vaccines for people ages 12 and above, and authorized them for emergency use in children ages 6 months through 11 years, rather than only aiming at the high risk population.
This is good news because the original vaccine targets variants that are no longer circulating around the globe, namely the original COVID-19 and BA.4 and BA.5. The new family, XBB.1.5, has evolved to work around the previous vaccine. Hence, infection rates are increasing even among those up to date on vaccines. There is concern about the global rising infection rate, and no one wants a repeat of 2020 and 2021. Medical authorities want everyone vaccinated.
The flu vaccine is updated every year because it also mutates rapidly. The COVID vaccine will now be updated every year as well, and ready when the flu vaccine comes out every fall.
Moderna’s clinical trials data confirm that its updated monovalent COVID-19 vaccine also creates a strong immune response against BA.2.86, another rising variant.
Genesee County’s COVID hospitalization rate for the week ending September 2, 2023 had a 8.3% increase. This is typical across the country, with a few hot spots like the Atlanta, GA area with increases of 33.3%. It is the new variants causing this increase.
The hospitalization rate increase is the tip of the iceberg, as no one is counting COVID cases anymore, only hospital admissions.
The new vaccines will not be covered by the government.
Those days are over. Now coverage comes from your insurance carrier, but you need to stay within the limits of your plan. Call and ask where you should get it. The prices for the vaccines are later in this article.
I personally got the new Medicare Manual for 2024 in my email this week, available at https://www.medicare.gov/publications/10050-Medicare-and-You.pdf.
Here is what it says about Medicare coverage for COVID vaccines:
“You pay nothing for the COVID-19 vaccine. Be sure to bring your red, white, and blue Medicare card with you when you get the vaccine so your health care provider or pharmacy can bill Medicare. If you’re in a Medicare Advantage Plan, you must use the card from your plan to get your Medicare-covered services and, like other covered services, your plan may require that you get the vaccine from an in-network provider. If you’re in a Medicare Advantage Plan, you pay nothing when you get the vaccine from an in-network provider.”
Let me clarify that:
Regarding Original Medicare coverage: The provider MUST ACCEPT MEDICARE ASSIGNMENT for coverage. This means the provider accepts Medicare rates, will bill Medicare for you and will not send you a bill after the fact. Ask before you get the vaccine if they accept Medicare assignment.
The second important bit is IF YOU HAVE AN ADVANTAGE PLAN, YOU MUST USE THEIR IN-NETWORK PROVIDER. This would be insurances like the McLaren Advantage Plan or Genesys Advantage Plan for example. If you are in the McLaren plan, you have to use McLaren facilities. They may have a list of pharmacies or other locations they will accept. If you get a shot at a location that is NOT contracting with your plan, you will pay.
There are a mind-boggling 72 Medicare Advantage plans in Genesee County. So pull out your coverage cards and give them a call to see where you can get the vaccine for free.
Get more information from Medicare? Be wary of their website!
The Courier checked for updated information at Medicare.gov/medicare-coronavirus; as of September 12, 2023, it has not been updated with the current vaccine information. The new vaccine is for the monovalent XBB.1.5 strains, which is currently circulating the world.
The website as of this writing still states that the bivalent BA.4 and BA.5 vaccine is new, and it is not. That is old information. So be careful to check the dates on all articles you read to find the most recent information.
Where can I get it?
A national vaccination campaign is expected to be kicked off in the coming days. The Courier does not know as of publication date wheres or whens, but when we know more, we will share about it.
How much will the shots be if I don’t use insurance?
Pfizer/BioNTech: $120 per dose. Moderna: $129 per dose. Novavax: $130 per dose, its contracted price will be $72.50 per dose.
COVID test kits are no longer covered by government either.
But you can check here to find pharmacies and other locations doing free testing:
This link lists many testing sites in Flint, such as Word of Life Church, Bethel United Methodist and Macedonia Baptist Church, as well as Rite Aid. Drive-thru testing is available at Walgreens at 2815 Davison Road and Northpointe at 5710 Clio Rd. Schedule your appointment from the web page, or call to make sure this information is up to date before going.
Depending on your plan, your doctor can also send you to a lab that is covered by your insurance company.
It is a lot to think about, but all of this is now part of our daily lives. Contact your doctor if you have any questions about what is right for you.