The Costly Dilemma: New RSV Vaccines and Insurance Coverage

Some older adults in the United States are being charged over $300 for the new respiratory syncytial virus (RSV) vaccine, as certain insurance plans are not covering the cost. Medicare Part D, which pays for prescription drugs, covers the RSV vaccine, but Medicare enrollees without a Part D plan may have to pay out of pocket. Private health insurers have used loopholes to avoid covering the vaccine, claiming that shared clinical decision-making does not qualify as an official recommendation. Varying policies among health insurers make it important for individuals to check if their plan covers the cost before getting the vaccine.