Insurance confusion over new COVID vaccine as Long Islanders roll up their sleeves

As Long Islanders, eager to increase their protection against COVID-19, rolled up their sleeves to receive the new vaccine on Friday, some people were told their insurance companies did not yet cover the vaccines.

Paul Fein, 76, of Oceanside, said he made an appointment for himself and his wife at an Oceanside CVS for Friday afternoon, but when he got there, “they told me it wasn’t covered.”

Fein, 76, said the pharmacist told him, “Maybe we’ll figure it out on Monday.”

The Affordable Care Act, also known as Obamacare, requires insurance companies, with few exceptions, to cover vaccines recommended by the Centers for Disease Control and Prevention. The CDC did so on Tuesday.

However, as of Friday, “some payers are still updating their systems and may not yet be set up to cover updated COVID-19 vaccines,” CVS spokesperson Tara Burke said in a statement. “If this happens, patients are encouraged to check with their plans for more details and schedule an appointment at a later date.”

Jennifer Kates, senior vice president at KFF, a San Francisco-based health policy nonprofit, said the confusion “is part of the chaos of the early transition to the commercial market.”

The federal government purchased previous COVID-19 vaccines but does not pay for new ones, instead shifting most of the costs to insurance companies. Medicare and Medicaid also cover vaccines.

Spokespeople for Medicare and insurance company organizations, the New York Association of Health Plans and America’s Health Insurance Plans, based in Washington, D.C., said vaccines are covered without copays if administered in-network.

“We are not aware of any plans that do not cover the vaccine,” the New York organization’s spokeswoman, Leslie Moran, said Friday afternoon.

Fein, who has Medicare plus supplemental private insurance coverage, said insurance companies knew the vaccine would likely be approved this week and “should have had their ducks in a row.”

“I’m frustrated,” Fein said, because he’s traveling in three weeks and knows it may take a few weeks for the vaccine to be fully effective.

“I wanted to be on my journey knowing that I have all the protection I can get,” he said.

Some were luckier than Fein in avoiding insurance mistakes.

A CVS pharmacist in Commack told Susan Illions-Lee that her insurance covered the vaccine when she asked about receiving it.

“I’ve heard the numbers are going up and I’m older,” said Illions-Lee, 71, of Dix Hills, referring to the rising number of COVID-19 cases and hospitalizations, and people’s increased risk of severe illness. greater. adults have. “I had it once and I don’t want to have it again.”

Most CVS pharmacies on Long Island had the vaccine on Friday and those that didn’t would have supplies on Monday, said Amy Lynn Safaty, CVS pharmacy district leader.

“Demand has definitely been high,” he said. “Patients are very excited to have a new vaccine.”

People can receive the COVID-19 vaccine along with flu and RSV vaccines, he said.

It’s unclear whether initial demand will generate greater interest in the updated vaccine compared to the first two booster shots in 2021 and 2022. Less than 14% of Long Islanders received both boosters, according to state health department data .

The CDC recommends the vaccine for anyone 6 months and older.

Adults 65 and older and those with certain health conditions that make them more vulnerable to severe COVID-19 are most in need of the vaccine, said Dr. Mangala Narasimhan, senior vice president of critical care services at Northwell Health. .

Immunity from previous vaccines and previous COVID-19 infections wanes over time and the immune system is less able to fight off newer, ever-mutating strains of the virus, he said.

Although the CDC recommendation is broad, Narasimhan does not believe the new vaccine is necessary for young, healthy people.

“I don’t think it’s imperative unless they live with someone older and are afraid of bringing COVID home,” he said.

One reason is that the virus tends to cause less severe illness in healthy people than it did three years ago, he said.

Ivan Alvarez, 60, of East Northport, learned about the new vaccine from a pharmacist at Commack CVS when he was inquiring about a prescription. He is planning to receive it next week. He credits previous vaccines, including booster shots, for protecting him.

“It’s been three years and I never had COVID and I was able to continue working,” he said.

Mary Chalil, 64, of Commack, a licensed practical nurse, said she plans to get vaccinated to protect residents of the nursing home where she works.

“I work with older people and they are compromised,” he said, referring to how immune systems tend to be weaker among older adults. “And I want to protect myself and my family.”

Theresa Watt of East Meadow, CVS district performance coordinator, received the vaccine Friday morning, in part to protect her 80-year-old mother. But her mother, who received booster shots, is still “doing some research” before deciding whether she will get the new vaccine, she said.

Santos Reyes, 55, of Brentwood, said while shopping at CVS that she would ask her doctor about an updated vaccine for her and her 88-year-old mother. She said her doctor had recommended the 2022 booster to her mother, but said it was not necessary for her, even though she has diabetes, which puts her at higher risk for serious illness. Reyes said the doctor told her a blood test showed she still had antibodies to COVID-19.

But Narasimhan said those antibodies may not provide enough protection, especially with the new COVID-19 variants now circulating.

“I think a 55-year-old person with diabetes should definitely get vaccinated,” he said.

Michael Nunez, 29, of Brentwood, has never been vaccinated and does not plan to receive the new vaccine, even though he said his only bout with COVID was “hard” and kept him home from his job as a tree cutter for a week. He questioned the effectiveness of the vaccines because his friends contracted the virus after getting vaccinated.

Narasimhan said vaccines provide protection against infection for only about 12 weeks, but can prevent serious illness for much longer.

“Just because you got vaccinated doesn’t mean you won’t get COVID,” he said. “It just means you won’t get very sick, which is exactly what you want.”