COVID-19 vaccines for children 5-11 must be covered without cost sharing, CMS says

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Coverage for the COVID-19 vaccine for children ages 5-11 is available without cost-sharing under Medicare, Medicaid, and the Children's Health Insurance Program, and in the commercial market, the Centers for Medicare and Medicaid Services said on Wednesday.

Thanks to the American Rescue Plan Act of 2021, nearly all Medicaid and CHIP beneficiaries are eligible to receive coverage of the vaccines and their administration without cost-sharing, CMS said. Beneficiaries with Medicare pay nothing for COVID-19 vaccines or their administration, and there is no applicable copayment, coinsurance or deductible. 

COVID-19 vaccines and their administration will also be covered without cost-sharing for eligible consumers of most issuers of health insurance in the commercial market, CMS said. 

Providers and other entities administering COVID-19 vaccines must agree to administer COVID-19 vaccines at no out-of-pocket cost to recipients. Also, they cannot deny anyone a COVID-19 vaccination based on their health coverage status. These stipulations are based on the terms of the CDC COVID-19 Vaccination Program Provider Agreement.

CMS's reiteration of vaccine coverage follows the U.S. Food and Drug Administration's recent action authorizing the Pfizer-BioNTech COVID-19 vaccine for children ages 5 through 11 and a recommendation from the Centers for Disease Control and Prevention on Tuesday that endorsed the CDC Advisory Committee on Immunization Practices' recommendation for the vaccine for children in this age group.

Distribution of pediatric vaccinations across the country started this week, with plans to scale up to full capacity starting the week of November 8. Vaccines will be available at thousands of pediatric healthcare provider offices, pharmacies, Federally Qualified Health Centers and other locations.

WHY THIS MATTERS

This expands vaccine recommendations to about 28 million children in the United States in this age group and allows providers to begin vaccinating them as soon as possible. 

CDC site www.vaccines.gov offers available locations to get a vaccine.

Walgreens sent out an announcement that it would begin vaccinations for this age group starting on Saturday. Appointments are recommended.

THE LARGER TREND

As with all vaccines, the Pfizer-BioNTech COVID-19 vaccine was tested on this age group prior to its authorization for emergency use, health officials said. 

While the effects of COVID-19 for a child can last for several months, the most commonly reported side effects of the COVID-19 vaccine in the clinical trial participants were generally mild to moderate in severity, and most went away within one to two days.

But COVID-19 cases in children can result in hospitalizations, deaths, inflammatory syndromes and long-term complications, such as "long COVID," in which symptoms can linger for months, the CDC said. 

The spread of the Delta variant resulted in a surge of COVID-19 cases in children throughout the summer. During a 6-week period in late June to mid-August, COVID-19 hospitalizations among children and adolescents increased fivefold, the CDC said.

Similar to what was seen in adult vaccine trials, vaccination was nearly 91% effective in preventing COVID-19 among children aged 5-11 years. 

ON THE RECORD

"The COVID-19 vaccine is the best way to keep children safe. The strongest protection against COVID-19, including the Delta variant, is to get vaccinated," said CMS Administrator Chiquita Brooks-LaSure. "I encourage parents everywhere to talk with their pediatrician, school nurse, or other trusted healthcare provider about any questions they may have and to get their children vaccinated as soon as possible." 

CDC Director Dr. Rochelle P. Walensky said, "Together, with science leading the charge, we have taken another important step forward in our nation's fight against the virus that causes COVID-19. We know millions of parents are eager to get their children vaccinated, and with this decision, we now have recommended that about 28 million children receive a COVID-19 vaccine. As a mom, I encourage parents with questions to talk to their pediatrician, school nurse or local pharmacist to learn more about the vaccine and the importance of getting their children vaccinated." 

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com