Medicare AdvantageCoverageHigh impact
COVID-19 vaccines; No cost share for members
UPMC Health Plan·Reimbursement
Effective date
Jan 1, 2022
We identified it
Aug 7, 2026
Summary
UPMC Health Plan confirms COVID-19 vaccines remain covered with zero cost share for all members across all plan types (Medicare Advantage, commercial, Medicaid, and marketplace). As of January 1, 2022, UPMC for Life (Medicare Advantage) vaccination claims must be billed to UPMC Health Plan instead of Medicare Fee-for-Service. This clarification ensures proper claim routing and eliminates patient cost sharing for vaccine administration and products.
Action Required
By January 1, 2022 (retroactive to policy date): Billing team must immediately update claim submission protocols to route all COVID-19 vaccination claims for UPMC for Life (Medicare Advantage) members to UPMC Health Plan, NOT to Medicare Fee-for-Service. Update billing software rules and claim scrubbing logic to reflect this change. Verify all staff understand the new routing. Reference CMS billing guidance at cms.gov/COVIDvax and UPMC provider FAQ/Appendix A. Front desk staff must ensure zero cost share is applied at point of service for all UPMC plan members receiving COVID-19 vaccines. Failure to route claims correctly will result in claim denials or improper Medicare billing.