State now requires insurers to cover COVID-19 vaccinations

PORTLAND, Ore. — The State of Oregon now requires health benefit plans in Oregon to cover costs of vaccination for COVID-19, following an order by state Public Health Director Rachael Banks.

The Jan. 27 determination cites Oregon Revised Statute 743A.264 (2) and (3) in mandating that private health plans operating in Oregon not charge patients for most costs related to providing the vaccine. That includes the cost of all doses of the vaccine and associated supplies, and expenses for administering the shot, such as those related to staff time.

The Oregon Health Plan and Medicare programs do not charge patients for costs of vaccinations.

“We are in the midst of a devastating pandemic that has affected more than 142,000 people in Oregon and claimed almost 2,000 lives,” Banks said. “There should be no financial barrier to getting the vaccine, whether it’s a copay or administrative fee. Even small costs can be a big burden for people with limited resources, particularly considering the economic challenges people have faced for the last year.”

She said she encourages providers to bill patients’ insurance for any vaccination costs and avoid asking or expecting patients to cover vaccine administration costs.

In her order, Banks points to “[t]wo safe and effective COVID-19 vaccines (that) are currently approved by the U.S. Food and Drug Administration (FDA) under Emergency Use Authorization.” Both vaccines — one made by Pfizer-BioNTech, the other by Moderna — “are currently available to eligible individuals in Oregon. More COVID-19 vaccines may become available following clinical trials and approval by the FDA.”

Therefore, the order continues, “having determined there exists a disease outbreak and that vaccination is necessary to prevent the spread of COVID-19, the cost of vaccination for COVID-19 shall be covered by insurance …”

Oregonians who have questions about their insurance coverage are encouraged to contact their Coordinated Care Organization, insurance company or agent. If they still have questions or concerns, consumer advocates are available.

• Oregon Health Plan: Call Oregon Health Authority at 800-273-0557 (toll-free).
• Commercial insurance plans: Call the Oregon Division of Financial Regulation at 888-877-4894 (toll-free).
• Medicare: Call 800-633-4227 (toll-free).

Vaccinations in Oregon

OHA is providing daily updates on administered doses of COVID-19 vaccines in Oregon on its vaccination data dashboard.

The dashboard provides weekday updates on the number of people vaccinated, both by state and by county, along with key demographic information showing the race, ethnicity, sex and age of everyone who has been vaccinated.

Nearly 700 people applied to be on the Vaccine Advisory Committee (VAC).

Members were chosen by a cross-sectional team from Oregon Health Authority (OHA), Community Partner Outreach Program (CPOP) and Oregon’s Office of Equity and Inclusion (OEI).