Yes, vaccines are covered by both medical and prescription insurance, but the type of coverage depends on the vaccine and your insurance plan. Most vaccines are covered under your medical insurance (like Medicare Part B or private health plans), while some specific vaccines fall under prescription drug coverage (like Medicare Part D).
This guide will help you understand exactly which vaccines are covered by what type of insurance, how much you might pay, and what to do if you don’t have coverage.
How Vaccine Coverage Works With Different Insurance Types
Private Health Insurance Coverage
Most private health insurance plans must cover vaccines without charging you any out-of-pocket costs. This rule comes from the Affordable Care Act (ACA), which requires most health plans to cover preventive services like vaccines.
What’s covered under private insurance:
- All vaccines recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP)
- No copays, deductibles, or coinsurance when you use in-network providers
- Coverage includes the vaccine itself and the administration fee
- Protection for children up to age 26 on their parents’ plans
The only exception is “grandfathered” health plans that existed before the ACA. These older plans might not cover all vaccines for free.
Medicare Coverage: Part B vs Part D
Medicare covers vaccines under two different parts, which can be confusing. Here’s the simple breakdown:
Medicare Part B (Medical Insurance) covers:
- Annual flu vaccines
- COVID-19 vaccines
- Pneumonia vaccines (pneumococcal)
- Hepatitis B vaccines (for people at medium to high risk)
- Vaccines needed after injury or exposure (like tetanus or rabies)
Medicare Part D (Prescription Drug Coverage) covers:
- Shingles vaccines (Shingrix)
- Tdap vaccines (tetanus, diphtheria, whooping cough)
- HPV vaccines
- Hepatitis A vaccines
- Most other vaccines not covered by Part B
The good news is that since 2023, all Medicare-covered vaccines should be free to you, thanks to the Inflation Reduction Act.
Medicaid and CHIP Coverage
Medicaid provides excellent vaccine coverage. Starting in October 2023, most adults with Medicaid coverage get all CDC-recommended vaccines at no cost, according to CDC guidelines.
Medicaid covers:
- All vaccines recommended by ACIP
- No cost-sharing for eligible adults
- Children’s vaccines through the Vaccines for Children (VFC) program
Military Insurance (TRICARE)
TRICARE covers all vaccines according to the CDC’s recommended schedule. You might have a small copay depending on your specific TRICARE plan.
Which Vaccines Are Typically Covered
Always Covered by Most Insurance Plans
These vaccines are covered by nearly all insurance types:
- Annual flu vaccine – Recommended for everyone 6 months and older
- COVID-19 vaccines – All updated formulas and boosters
- Tetanus, diphtheria, and pertussis (Tdap) – Boosters every 10 years
- Pneumonia vaccine – Especially important for adults over 65
- Shingles vaccine – Recommended for adults 50 and older
- HPV vaccine – For teens and young adults up to age 26
Vaccines That May Have Limited Coverage
Some vaccines might not be covered by all insurance plans:
- Travel vaccines (yellow fever, typhoid, Japanese encephalitis)
- Vaccines not recommended by ACIP
- Vaccines for occupational exposure (unless required by your job)
Understanding Your Coverage
Check Before You Go
Before getting any vaccine, it’s smart to:
- Call your insurance company to confirm coverage
- Ask about in-network providers to avoid extra costs
- Verify if you need a prescription for certain vaccines
- Check if your doctor’s office or pharmacy is preferred
Where to Get Vaccinated
You can usually get vaccines at:
- Your doctor’s office
- Pharmacies like CVS, Walgreens, or local pharmacies
- Community health centers
- Urgent care clinics
Each location might bill your insurance differently, so ask about costs upfront.
Costs Without Insurance
If you don’t have insurance, vaccine costs can add up quickly:
Typical Vaccine Costs Without Insurance
- COVID-19 vaccines: $90-$200 per dose
- Flu shots: $30-$50
- Shingles vaccine: Around $200 per dose (you need 2 doses)
- Tdap booster: $40-$80
- HPV vaccine: $250-$400 per dose (you need 2-3 doses)
Programs for Uninsured People
Don’t give up if you don’t have insurance. Several programs can help:
For Children:
- Vaccines for Children (VFC) program provides free vaccines to eligible kids under 19
- Children qualify if they’re on Medicaid, uninsured, or American Indian/Alaska Native
For Adults:
- Federally Qualified Health Centers (FQHCs) offer sliding scale fees
- State health departments often have adult immunization programs, as noted by the U.S. Department of Health and Human Services
- Community health centers may offer free or low-cost vaccines
- Pharmacy assistance programs from manufacturers
What to Do If Your Vaccine Isn’t Covered
Appeal the Decision
If your insurance denies coverage for a recommended vaccine:
- Ask your doctor to write a letter explaining why you need the vaccine
- Submit a formal appeal to your insurance company
- Contact your state insurance commissioner if the appeal fails
- Look into patient assistance programs from vaccine manufacturers
Find Alternative Coverage
Consider these options:
- Change insurance plans during open enrollment
- Look into short-term insurance for specific needs
- Check if you qualify for Medicaid or other government programs
- Ask about payment plans at your provider’s office
Tips for Getting the Best Vaccine Coverage
Timing Matters
- Get vaccines during routine check-ups to avoid separate visit fees
- Schedule preventive care visits when vaccines are due
- Check if your plan covers vaccines during physical exams
Know Your Plan Details
- Read your Summary of Benefits to understand vaccine coverage
- Keep track of which vaccines you’ve had to avoid unnecessary shots
- Ask about combination vaccines that might be more cost-effective
Use In-Network Providers
- Stay within your insurance network to avoid extra charges
- Ask pharmacies about insurance acceptance before getting vaccinated
- Confirm coverage even for routine vaccines like flu shots
Special Considerations
Children and Vaccines
Parents should know that:
- Most insurance plans cover all childhood vaccines at no cost
- Children can stay on parents’ plans until age 26
- School-required vaccines are typically covered
- The VFC program helps uninsured children get free vaccines
Vaccines for Chronic Conditions
If you have conditions like diabetes, heart disease, or immune system problems:
- You may qualify for additional vaccines that are covered
- Your doctor can help determine which vaccines you need
- Insurance often covers vaccines for high-risk individuals
Travel Vaccines
Planning a trip? Remember:
- Most travel vaccines aren’t covered by insurance
- Some exceptions exist for vaccines that also prevent domestic diseases
- Check with your doctor about which vaccines are truly necessary
- Consider the cost when planning your travel budget
Final Thoughts
Vaccines are one of the best ways to protect your health and the health of your community. The good news is that most vaccines are covered by insurance, whether through your medical plan or prescription drug coverage.
Remember these key points:
- Most vaccines are covered at no cost to you
- Different insurance types cover different vaccines
- Always check with your insurance before getting vaccinated
- Help is available if you don’t have insurance
Don’t let cost keep you from getting the vaccines you need. If you’re unsure about coverage, talk to your healthcare provider or call your insurance company directly.