Insurance confusion over new COVID vaccine as Long Islanders roll up sleeves 

As Long Islanders eager to increase their protection against COVID-19 rolled up their sleeves to get the new vaccine on Friday, some people were told their insurance companies were not covering the vaccinations yet.

Paul Fein, 76, of Oceanside, said he made an appointment for him and his wife at an Oceanside CVS for Friday afternoon but when he got there, “I was told it’s not covered.”

Fein, 76, said the pharmacist told him, “Maybe we’ll get it straightened out by Monday.”

The Affordable Care Act, also known as Obamacare, requires insurance companies, with few exceptions, to cover vaccines recommended by the Centers for Disease Control and Prevention. The CDC did so on Tuesday.

Yet on Friday “some payers are still updating their systems and may not yet be set up to cover the updated COVID-19 vaccines,” CVS spokeswoman Tara Burke said in a statement. “If this happens, patients are encouraged to check with their plans for more details and schedule an appointment at a later date.”

Jennifer Kates, a senior vice president at the San Francisco-based health-policy nonprofit KFF, said the confusion “is part of the chaos of early transition to the commercial market.”

The federal government bought the previous COVID-19 vaccines but is not paying for the new ones, instead shifting most costs to insurance companies. Medicare and Medicaid also cover the vaccines.

Spokespeople with Medicare, and with insurance company organizations the New York Health Plan Association and the Washington, D.C.-based America’s Health Insurance Plans, said the vaccines are covered with no copays if they are administered in-network.

“We are not aware of any plans not covering the vaccine,” the New York organization’s spokeswoman, Leslie Moran, said late Friday afternoon.

Fein, who has Medicare plus supplemental private-insurance coverage, said insurance companies knew the vaccine likely was going to be approved this week and “they should have had their ducks in a row.”

“I’m frustrated,” Fein said, because he is traveling in three weeks and knows it can take a few weeks for the vaccine to be fully effective.

“I wanted to be on my trip knowing I have as much protection as I can get,” he said.

Some had more luck than Fein in avoiding insurance foul-ups.

A pharmacist at the CVS in Commack told Susan Illions-Lee that her insurance covered the vaccine when she inquired about getting the shot.

“I heard the numbers are going up, and I’m older,” said Illions-Lee, 71, of Dix Hills, referring to the rising number of COVID-19 cases and hospitalizations, and to the increased risk of severe disease that older adults have. “I had it once and I don’t want to get it again.”

Most CVS pharmacies on Long Island had the vaccine by Friday and those that didn’t would have supplies by Monday, said Amy Lynn Safaty, a pharmacy district leader for CVS.

“Demand has definitely been high,” she said. “Patients are very excited to have a new vaccine.”

People can get the COVID-19 shot together with flu and RSV vaccinations, she said.

It’s unclear whether the initial demand will lead to greater interest in the updated vaccine compared to the first two booster shots in 2021 and 2022. Fewer than 14% of Long Islanders got both boosters, according to state health department data.

The CDC recommends the vaccine for anyone 6 months or older.

Adults 65 and older and those with certain health conditions that make them more vulnerable to severe COVID-19 are most in need of the vaccine, said Dr. Mangala Narasimhan, senior vice president for critical care services at Northwell Health.

Immunity from previous vaccinations, and from prior COVID-19 infections, wanes over time, and the immune system is less able to fight the newer strains of the constantly mutating virus, she said.

Although the CDC recommendation is broad, Narasimhan doesn’t believe the new vaccine is necessary for young, healthy people.

“I don’t think it’s imperative unless they live with someone who is elderly and they’re afraid to bring COVID home,” she said.

One reason is that the virus tends to cause less severe disease in healthy people than three years ago, she said.

Ivan Alvarez, 60, of East Northport, heard about the new vaccination from a Commack CVS pharmacist when he was inquiring about a prescription. He’s planning to get it next week. He credits previous vaccinations, including boosters, with protecting him.

“It’s been three years and I never got COVID, and I was able to keep working,” he said.

Mary Chalil, 64, of Commack, a licensed practical nurse, said she plans to get the vaccine to protect the residents at the nursing home where she works.

“I work with senior citizens and they’re compromised,” she said, referring to how immune systems tend to be weaker among older adults. “And I want to protect myself and my family.”

Theresa Watt, of East Meadow, a district performance coordinator for CVS, got the shot Friday morning, in part to protect her 80-year-old mother. But her mom, who received booster shots, is still “doing a little research” before deciding whether to get the new vaccine, she said.

Santos Reyes, 55, of Brentwood, said while shopping at CVS that she would ask her doctor about an updated vaccine for herself and her 88-year-old mother. She said her doctor had recommended the 2022 booster for her mother but said it wasn’t necessary for her, even though she has diabetes, which puts her at higher risk for severe disease. Reyes said the doctor told her a blood test showed she still had antibodies against COVID-19.

But Narasimhan said those antibodies may not provide sufficient protection, especially with the new COVID-19 variants now circulating.

“I think a 55-year-old person with diabetes definitely should get the vaccine,” she said.

Michael Nuñez, 29, of Brentwood, has never gotten vaccinated and isn’t planning to get the new vaccine, even though he said his one bout with COVID was “strong” and kept him home from his job as a tree-cutter for a week. He questioned the effectiveness of the vaccines because friends contracted the virus after getting vaccinated.

Narasimhan said the vaccines provide protection against infection for only about 12 weeks, but can prevent serious illness for significantly longer. 

“Just because you got vaccinated doesn’t mean you’re not going to get COVID,” she said. “It just means you won’t get super-sick from it, which is exactly what you want.”

By David Olson

david.olson@newsday.com@DavidOlson11

David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.