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Most health insurance plans cover the cost of vaccines, but you may want to check with your insurance provider before going to the doctor.
The Affordable Care Act – the health insurance reform legislation passed by Congress and signed into law by President Obama in March 2010 – requires new health plans to cover preventive services and eliminates cost sharing (such as co-pays and deductibles for certain services). You may be eligible for preventive services including coverage for vaccines.
The Marketplace is a new way to find quality health coverage. It can help if you don’t have coverage now or if you have it but want to look at other options. The Health Insurance Marketplace is sometimes known as the health insurance "exchange." With one Marketplace application, you can learn if you can get lower costs based on your income, compare your coverage options side-by-side, and enroll.
When you use the Health Insurance Marketplace, you'll fill out an application and see all the health plans available in your area. You'll provide some information about your household size and income to find out if you can get lower costs on your monthly premiums for private insurance plans. You'll learn if you qualify for lower out-of-pocket costs.
The Marketplace will also tell you if you qualify for free or low-cost coverage available through Medicaid or the Children's Health Insurance Program (CHIP). Most Americans will be eligible to use the Marketplace. Learn more about Marketplace eligibility.
If you do not currently have health insurance, visit www.HealthCare.gov for more information about finding health insurance or the Affordable Care Act.
If you don't have insurance, or if it does not cover vaccines, the Vaccines for Children (VFC) program may be able to help. This program provides vaccines at no cost to doctors who serve eligible children. Children younger than 19 years of age are eligible for VFC vaccines if they are Medicaid-eligible, American Indian or Alaska Native or have no health insurance. "Underinsured" children who have health insurance that does not cover vaccination can receive VFC vaccines through Federally Qualified Health Centers or Rural Health Centers.
Parents of uninsured or underinsured children who receive vaccines at no cost through the VFC Program should check with their doctor about possible administration fees that might apply. These fees help providers cover the costs that result from important services like storing the vaccines and paying staff members to give vaccines to patients. However, VFC vaccines cannot be denied to an eligible child if a family can’t afford the fee. Depending on where you live, you may also qualify for Medicaid assistance.
If you are 65 years or older and a Medicare beneficiary, Medicare will pay for part or all of your influenza (flu), pneumococcal (pneumonia) and hepatitis B vaccines.