Is the COVID-19 vaccine covered by UPMC Health Plan? Is it covered at no cost?
Yes. The COVID-19 vaccine is covered as a preventive service at no cost to you.*
When can I get the vaccine?
Pennsylvania is delivering vaccines to be administered in “phases” that prioritize health care workers and other high-risk groups. The state has not yet announced availability for most members of the general public.
I read that the vaccine is now available for anyone over 65 and people 16-64 who have other health conditions. I’m in one of these groups. When can I get my vaccine?
The Pennsylvania Department of Health announced that more people should be added to the 1A priority vaccination group. However, vaccine manufacturing and distribution are still limited.
UPMC is working closely with the state to get more vaccines and we know that many of our other network providers and pharmacies are also preparing for expanded distribution. We are hopeful that vaccines will soon be available to the public at hospitals, pharmacies, and community sites. We know our members are eager to get the vaccine. Our goal is to help, and we will share more information as soon as it is available.
I’ve heard some health systems or providers are now scheduling vaccine appointments for patients. Can you schedule an appointment for me at UPMC?
Because of limited vaccine availability, UPMC is not yet able to schedule vaccine appointments. We will post information here when we are able to take these kinds of requests.
Which phase am I in? (see links to PA Department of Health for more in-depth descriptions)
Phase descriptions are current as of January 20, 2021 and are subject to change based on PA Department of Health guidance.
I have heard about changes to the federal government’s plan for distribution. How does this impact the phases in Pennsylvania?
The federal government, working primarily through the CDC, generally issues recommendations for state distributions of the vaccine. Note that each state is ultimately responsible for its own distribution plan. Pennsylvania has made a number of updates to its vaccination plan and has already said that more updates are likely as additional information or guidance is available from the federal government. UPMC Health Plan does not restrict or limit your coverage based on changes to the vaccination plan – whenever the vaccine is available to you, it is covered by your plan. The most current vaccination plan for Pennsylvania is available from the Pennsylvania Department of Health.
I found a site on the Pennsylvania Department of Health map that says vaccines are available…
I heard my pharmacy has doses…
My neighbor got a shot from her doctor – can you help me schedule an appointment?
Unfortunately, in many cases showing availability of vaccine on the PA Department of Health map does not actually mean that a site or provider is currently able to take vaccination appointments. In other situations, a vaccination site may have had a small surplus of doses to distribute even though they cannot regularly accept a large number of vaccination appointments today. This may be because they have run out of doses or because any appointments they do have are currently full. Even when appointments are available it is common to see only a small number of slots and for those slots to rapidly close. Vaccine supplies are still limited at the federal and state level so many sites and providers are able to schedule only intermittently when they actually have unused doses in stock. Our Health Care Concierge team is always happy to help schedule an appointment for care with a provider, but this rapidly changing situations means that we don’t currently have additional information about which providers, pharmacies, or other sites are actively scheduling COVID-19 vaccination appointments.
Why is it taking so long?
The currently available COVID-19 vaccines have very specific criteria for deep cold storage, transportation, and tracking, which make the process of delivering these vaccines much more complicated than other vaccines (e.g., shingles, flu). Because of limited national supplies and the complexities of distribution, the vaccine may still take several months to be available to you. You can get more information and stay informed at UPMC’s COVID-19 website and the CDC’s COVID-19 website.
Where and how can I get the vaccine?
Do I need to make an appointment?
Yes. You will need to make an appointment to get the vaccine. Some providers or pharmacies may have specific instructions about how to schedule this visit. Be sure to contact the location where you’d like to get the vaccine before going.
Do I have to get the COVID-19 vaccine from a primary care provider (PCP)?
No. Due to the storage limitations for the vaccine, your PCP may not initially have the vaccine. You may get your vaccine from a PCP, hospital, pharmacy, or other health care provider whenever it is available to you.
Do I have to get the COVID-19 vaccine from a network provider?
While we encourage you to continue using network providers for purposes of quality and care coordination, you are not required to see a network provider to receive the COVID-19 vaccine at no cost ($0).
Do UPMC hospitals have the COVID-19 vaccine available?
Although many hospitals, including UPMC, are receiving limited shipments of the first COVID-19 vaccines, the Pennsylvania Department of Health has called for phased distribution throughout Pennsylvania. While the number of people in Pennsylvania’s Phase 1A was recently expanded, UPMC and many other providers do not yet have the additional vaccines necessary for general distribution. Vaccine doses should be more widely available soon.
Vaccine information and updates from UPMC are available on UPMC’s COVID-19 website.
Can you help me find a provider that has the COVID-19 vaccine available?
Vaccine distribution is being handled by the federal and state government. Vaccine doses are first being shipped to hospitals and nursing homes for frontline health care workers and patients who are at the highest risk. This plan is based on recommendations from the CDC. We do not yet know when the vaccine will be available to the general public, though the expectation is that vaccines will start to become available for seniors and certain other at-risk individuals near the beginning of February. Information about vaccine availability may change frequently, and we encourage you to check for updates from the Pennsylvania Department of Health and UPMC’s COVID-19 website for the latest news and information.
Can I get the COVID-19 vaccine at a pharmacy?
Yes, UPMC Health Plan will cover your COVID-19 vaccine regardless of whether you receive it from a hospital, pharmacy, or other licensed health care provider. Keep in mind that the first vaccine doses sent to pharmacies are still being distributed in accordance with the CDC and State Department of Health recommendations, so many pharmacies do not have vaccines available for the general public.
Where can I find more official information about the status of COVID-19 vaccine distribution and when I might be able to get it?
The Pennsylvania Department of Health has published its vaccination plan for Pennsylvania on their website (see Pennsylvania COVID-19 Interim Vaccination Plan).
If you are currently living or staying outside of Pennsylvania, you should check with the Health Department of the state that you are currently in.
Once the vaccine is more widely available, you will be able to locate vaccine locations on the CDC’s VaccineFinder portal, vaccinefinder.org
Once there are multiple types of vaccine available, can I choose the one that I receive?
While there is likely to be more than one vaccine option available, the availability of any particular manufacturer’s vaccine may be limited based on your geographic location or the provider that is providing your vaccine. Even when more than one vaccine is available, distribution will remain limited and it is not likely that a single provider will offer a “menu” of vaccine options in the near future. However, UPMC Health Plan does not currently impose any coverage limitation based on the type of FDA-emergency use authorized vaccine that you receive.
I’m currently in a state other than Pennsylvania – will the COVID-19 vaccine be covered if I get it here?
Yes. There is no coverage requirement related to the state in which you receive the vaccine.
What if my provider bills me for the vaccine? Do I have to pay up front?
Providers should not bill you for the COVID-19 vaccine. During the initial phase of distribution, vaccine doses are being paid for by the federal government. While providers are allowed to charge for an office visit and administration of your vaccine, those charges should be billed to your health insurer or, if you are uninsured, submitted to the federal government’s Provider Relief Fund.
If you are a UPMC Health Plan member and you receive a provider bill related to receipt of a COVID-19 vaccine, you should contact the Health Care Concierge team by calling the number on your member ID card or by visiting our website. If you have UPMC for Life or UPMC for Life Complete Care, your provider should bill Medicare.
Is the vaccine safe? Does UPMC recommend that everyone get the vaccine?
Vaccines are a safe and effective way to protect yourself and those around you from serious illnesses. Like all vaccines in the United States before being made available, the COVID-19 vaccine(s) underwent clinical trials and scientific evaluation that includes multiple levels of review for safety and effectiveness. This process is administered by the FDA and the CDC Advisory Committee on Immunization Practices (ACIP).
If you have questions about whether the COVID-19 or any vaccine is recommended for you, you should talk to your health care provider.
*This applies to all of our comprehensive medical coverage products, including Medicare Advantage (UPMC for Life), Special Needs Plan (UPMC for Life Complete Care), Medicaid (UPMC for You), CHIP (UPMC for Kids), UPMC Community Health Choices, and all UPMC commercial group and individual (Pennie/Marketplace) products. Members of Community Care Behavioral Health (CCBH) should contact their Physical Health MCO regarding coverage. Coverage does not apply for standalone dental, EAP, wellness-only, or other limited scope benefit products. Coverage applies to the FDA-emergency use authorized vaccines administered in the United States.