How to Pay for Vaccines
All Health Insurance Marketplace plans and most other private insurance plans must cover certain vaccines without charging a copayment or coinsurance when provided by an in-network provider. This is true even for patients who have not met a yearly deductible. Doses, recommended ages, and recommended populations for vaccinations vary. The following vaccines are usually covered by health insurance:
- Hepatitis A
- Hepatitis B
- Herpes Zoster
- Human Papillomavirus
- Measles, Mumps, Rubella
- Tetanus, Diphtheria, Pertussis
Check with your insurance provider for coverage details. Under the Affordable Care Act, insurance plans that cover children now allow parents to add or keep adult children on their health insurance policy until they turn 26 years old.
CDC now recommends that adolescents and young adults 16 through 23 years old may get a serogroup B meningococcal vaccine. Health plans are required to cover new vaccine recommendations in the next plan year. Check with your insurance provider for details on whether there is any cost to you for this vaccine.
Medicare Part B will pay for the following:
- Influenza (flu) vaccines
- Pneumococcal vaccines
- Hepatitis B vaccines for persons at increased risk of hepatitis
- Vaccines directly related to the treatment of an injury or direct exposure to a disease or condition, such as rabies and tetanus
Medicare Part D plans identify covered vaccines through formularies. Part D plan formularies must include all commercially available vaccines (except those covered by Part B). A new preventive vaccine may not specifically appear in the formulary, but the plan may still cover the vaccine. Contact your plan to find out about coverage.
Medicare Part D or Medicare Advantage Plan Part C that offers Medicare prescription drug coverage may also have coverage for the following:
- Zoster (shingles) vaccine
- MMR vaccine
- Tdap vaccine
Most state Medicaid agencies cover at least some adult immunizations, but some may not offer any vaccines. Check with your state Medicaid agency for more information.
If you serve in the military or are a military dependent, you are eligible for TRICARE. Under TRICARE, vaccines are covered according to the CDC recommended schedule.
If you do not currently have health insurance, visit www.HealthCare.gov to learn more about affordable health coverage options.