Does health insurance cover vaccines?

Crawford Frazer

Vaccines can be invaluable in making sure you don't have to take a week of sick time during flu season. They even can save your life. Thanks to their widespread availability, vaccines make serious illnesses entirely preventable.

For many, however, the importance of not getting sick and spreading that sickness to others is outweighed by an inability to pay. Fortunately, there are ways to make vaccines more affordable -- and, because of federal health care reform, they may even be free.

What health care reform means for vaccines

The health care reform law mandates that insurance companies cover certain preventive treatments without requiring you to pay a co-payment, co-insurance or a deductible. This provision of the law went into effect in September 2010. If you have Medicare, you're in luck; as of 2011, Medicare covers many preventative services for free as well.

Some of the vaccinations that now must be covered for free, according to the U.S. Department of Health and Human Services (HHS) are:

  • Routine shots for things like measles, polio or meningitis.
  • The flu vaccine.
  • Pneumonia vaccines.
  • Vaccines that ensure healthy pregnancies.
  • Hepatitis A and B vaccines.
  • Human papillomavirus (HPV) vaccines.

Keep in mind, however, that are some exceptions:

  • "Grandfathered" plans are exempt from these new rules. So if your health insurance plan was created before March 23, 2010, these services may not be free.
  • If you seek vaccines outside of your health insurance network, extra fees may be involved.
  • If a preventive care service is not the primary reason for a doctor visit, you may have to pay for some of the costs associated with that visit. For example, if your doctor gives cholesterol screening test (one of the free procedures HHS lists) as part of another visit, you'll still have to pay for the visit.

Other options

Even if your plan is grandfathered, vaccines still may be covered. Many plans do cover them, according to HHS, but you'll want to check before visiting the doctor. If you or your family doesn't have health insurance, some options, according to HHS' Vaccines.gov site, include:

  • Vaccines for Children (VFC) program: Under this program, vaccines are donated to doctors who serve eligible children. Kids younger than 19 can receive VFC vaccines if they are eligible for Medicaid, belong to certain groups (American Indians or Alaska Natives) or have no health insurance.
  • Retail clinics: Many retail chains, including Target, Walmart, CVS and Walgreens, have clinics that offer certain preventive services such as vaccines. Such clinics often are open evenings and weekends, and they often offer vaccines for less than what you'd pay at a doctor's office. CVS' Minute Clinic, for example, offers flu shots for $29.95.
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