Are vaccines covered by health insurance? The short answer is yes. Many options are available to be vaccinated, and it’s likely there’s at least one option that works for you.
Private insurance plans falling under the Affordable Care Act cover vaccines recommended for routine use by the Centers for Disease Control and Prevention. If cost is a concern, you can call your health plan and confirm the coverage for the vaccines.
Children younger than 19 years old, who are Native Americans, Medicaid eligible, or underinsured, qualify for the Vaccine For Children program. This federally funded program provides vaccines at no cost to children who might not otherwise be vaccinated because of inability to pay.
Over half of vaccines given in the U.S. to children are paid for by the program. Many doctor’s offices and health clinics participate in the Vaccine For Children program. If your child qualifies, you should ask if the clinic participates in the program before you book an appointment.
Older adults can receive some vaccines under Medicare. Medicare Part B covers doctor clinic visits and provides for the annual flu vaccine, both pneumococcal vaccines and the hepatitis B vaccine.
In addition, Part B provides vaccines for exposure to vaccine preventable diseases. For example, it will cover a tetanus vaccine following stepping on a rusty nail. Those who chose to add Part D (prescription coverage) can receive most other recommended vaccines including the shingles and whooping cough vaccines.
Because it’s a prescription coverage, it’s usually more affordable to obtain the vaccines from the pharmacist instead of the doctor’s office.
If you don’t have health insurance, you still can — and should — be vaccinated to stay healthy. If the cost at the pharmacy is too high, try calling around to other pharmacies as the price may vary. Local federally funded health centers, or community health centers, provide vaccines on a sliding price scale depending on your income.
Another option are online drug coupons. Many companies offer markedly reduced prescription medications and vaccinations. They can be found with a quick online search.
The cost of not being vaccinated may be more than bargained for. An illness due to a vaccine preventable disease may result in missed work, costing more in lost wages than the cost of a shot in the arm. The potential price paid for medications, hospitalization and just plain feeling miserable far outweigh the cost of prevention.