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New Mexico Insurance Office: COVID-19 vaccinations must be free of charge

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Russell Toal, New Mexico Superintendent of Insurance
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Courtesy photo

SANTA FE, NM – The New Mexico Office of Superintendent of Insurance (“OSI”) has directed all health insurers operating in the state to cover COVID-19 vaccinations and related services at no cost to a patient.

“Costs must not be a barrier to getting a COVID-19 vaccine,” said Superintendent Russell Toal. “Having a number of safe and effective vaccines available marks a turning point in the fight against this deadly virus – but a vaccine is only effective if people can afford to get vaccinated.”Every major medical plan must cover any costs associated with the administration of a COVID-19 vaccine for every covered New Mexican. Patient cost sharing – coinsurance, copayments and deductibles - cannot be applied, regardless of whether or not the provider administering the vaccine is in a health plan’s network. OSI’s order requires all insurers and health plans to immediately comply with the order as each new COVID-19 vaccine receives an Emergency Use Authorization from the United States Food and Drug Administration (“FDA”).

“Since the start of this pandemic, New Mexico has made sure that COVID-19 testing and treatment was available at no cost to state residents,” said Governor Michelle Lujan Grisham. “Removing cost barriers to vaccinations is a critical next step as we ramp up our efforts to distribute the vaccine to communities across our state.”

Providers are not permitted to charge patients or insurers for any vaccine, as the vaccines have been purchased using federal funds. Providers may charge a fee to cover the costs of administering the vaccine, but the charge cannot be passed on to patients, nor can Providers charge a patient for the office visit. These charges must be billed to the health plan. Uninsured patients cannot be denied access to the vaccine; providers who serve the uninsured can be reimbursed through the CARES Act’s Provider Relief Fund.

Individuals who are told they must pay for a COVID-19 vaccination or for the costs of administering the vaccine should immediately report the issue to OSI’s COVID-19 Health Insurance Hotline by calling 1-833-415-0566. OSI can help you resolve your issue and make sure that this doesn’t happen to others.

The OSI encourages all New Mexicans to get vaccinated as soon as a vaccine is available to them.