How the Affordable Care Act Increases Access to Influenza Vaccination for Health Care Personnel

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Are immunizations covered by health insurers under the Affordable Care Act?

Under the Affordable Care Act, non-grandfathered, private health plans will cover a range of recommended preventive services with no cost-sharing (such as copays and deductibles) by the beneficiary, including vaccinations recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP).

Will all health insurance plans cover influenza vaccinations?

Employer-sponsored health plans that were in operation before passage of the Affordable Care Act (March 23, 2010) and that have not changed much since passage of the law are “grandfatheredExternal.” These plans are exempt from many of the new standards of the Affordable Care Act.

Some of these grandfathered plans cover immunizations, but some do not. Check with your health insurance carrier to see if your plan covers immunizations.

Health insurers and non-grandfathered group plans must cover preventive services, including immunizations recommended by the ACIP, without cost-sharing (such as copays and deductibles).

In 2013, 36% of persons with health coverage through their jobs were enrolled in a grandfathered health plan, down from 48% in 2012, according to the Kaiser Family Foundation’s most recent Employer Health Benefits SurveyExternal. More plans are expected to lose grandfathered status over time.

Does Medicaid also cover influenza vaccinations?

A number of health care personnel (HCP) working in long-term care (LTC) settings may be eligible for Medicaid. States have the flexibility to choose whether to cover vaccinations for adults, and many states cover some or all of the ACIP recommended vaccines for adults. The Centers for Medicare & Medicaid Services is currently working to identify gaps in adult immunization activities and to develop recommendations to improve vaccination rates in adults. For more information on what adult immunizations are covered, please refer to your State’s Medicaid Manual and/or agency representative.

Can my organization give employees influenza vaccinations and be reimbursed by our health insurer?

To be reimbursed by your health insurance carrier for giving influenza vaccinations, your organization will need to become a provider for your health insurance carrier. If you are not already a provider, ask your health insurance carrier how to become a provider, and whether you can be reimbursed for giving influenza vaccinations to your employees.

If you do not already provide insurance to your employees and would like information on how to provide insurance, please visit https://www.healthcare.gov/small-businesses/External

How does the Affordable Care Act expand health insurance coverage for more people?

For persons not covered by health insurance, the Affordable Care Act makes health insurance more available in three primary ways:

  • The Affordable Care Act sets up a Health Insurance Marketplace where consumers can go to compare available insurance plans and enroll in the one they choose.
  • The Affordable Care Act promotes the expansion of the Medicaid program.
  • The Affordable Care Act reforms insurance market rules (e.g., it eliminates denial of coverage for pre-existing conditions).

The Health Insurance MarketplaceExternal began enrollment in October 2013 and began coverage on January 1, 2014.