There is a massive amount of wasteful spending in healthcare. Credible research suggests that roughly one-quarter of our total healthcare spending is wasted on low-value care, administrative complexity, including prior authorization processing, and failure of care delivery.
However, there is at least one area in healthcare that is indisputably high value: vaccines. Vaccines are widely regarded as the most cost-beneficial intervention in healthcare. Unfortunately, and counterintuitively, current cost-sharing policies discourage our most vulnerable population – seniors – from accessing vaccines.
Most private insurance policies or Affordable Care Act (ACA) plans provide coverage for vaccines without any out-of-pocket cost to the patient to encourage patients to be vaccinated. Regrettably, the same cannot be said for Medicare. Medicare coverage of vaccines for seniors is a tale of two cities. Vaccines paid for through Medicare Part B that are recommended by the Advisory Committee on Immunization Practices (ACIP) require zero out-of-pocket costs for patients. However, newer vaccines recommended by ACIP, except those for COVID-19, are covered under the Medicare Part D benefit and require an out-of-pocket expense for the beneficiary that can range from a few dollars to the entire cost of the vaccine.
