Medicare beneficiaries are less likely to receive free vaccines than those with commercial plans, according to a report from Avalere Health.
About 12% of those enrolled in a Medicare Advantage Prescription Drug plan could receive recommended vaccines for no out-of-pocket costs in 2015 and no standalone Medicare Part D plans offered that access, according to the report.
The Affordable Care Act requires most commercial insurance plans to offer recommended vaccines at no cost to enrollees. This provision does not extend to Medicare Part D, although the CMS has encouraged those plans to create a vaccine tier and provide vaccines with little or no cost sharing.
Caroline Pearson, senior vice president at Avalere, said she was struck by the low coverage rates for seniors. Preventive measures such as vaccines lack a sense of urgency, so any payment barrier can keep a patient from getting one.
“There's lots of evidence that cost sharing can really reduce the use of preventative services,” she said.
The report looked at 10 vaccines recommended for seniors by the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices and their formulary tier placement in Medicare plans from 2011 to 2016. The vaccines studied included those protecting against what Pearson called “reasonably serious and preventable diseases,” including shingles, tetanus, meningitis and hepatitis A.
Copays to get the vaccines ranged from $42 to $54 for Medicare Advantage plans and from $35 to $75 for standalone plans. If the beneficiary hasn't reached the drug deductible, which can be as high as $360, he or she would have to pay the full cost, which ranges from $38.03 to $276.65, according to the report.
Pearson said legislation involving Medicare can be politically challenging, but there are some easier changes that could improve coverage. One would be to include vaccination rates of beneficiaries in the criteria that determines a plan's star rating.
Vaccine coverage for adults in the U.S. is generally low, even though there are more vaccine-preventable diseases among adults than children. The coverage rates for seniors range greatly between vaccines. Nearly 72% of those 65 and older received a flu vaccine in 2014 while not quite 6% received the vaccine for hepatitis A, according to the CDC.
