Which Vaccines Does Insurance Cover? Medicare, Private Plans, and More

Vaccines are public health tools that help prevent infections, hospitalizations, and death. Since the 20th century, widespread global vaccination programs have transformed healthcare by fighting diseases and allowing millions of people to lead longer, healthier lives.

Without insurance, getting all the recommended shots can be costly. The Centers for Disease Control and Prevention (CDC) offers discounted vaccines to public sector vaccine administrators, such as health departments, at prices ranging from about $13 to more than $500 per dose. Prices paid by for-profit providers, such as retail pharmacies, and cash-pay consumers can be higher.

But because of the preventive health services provision of the Patient Protection and Affordable Care Act of 2010 (known as the Affordable Care Act, or ACA) and the Inflation Reduction Act of 2022, routine vaccines for adults and children are fully covered by most insurance plans. There is no cost sharing if you receive your vaccine from an in-network provider. Let's look at how different health insurance plans cover vaccines and what you can expect to pay - if anything - out of pocket.

Which vaccines does insurance cover?

Many vaccines licensed for use in the U.S. are covered by most insurance plans. The CDC provides this list of vaccines covered by different health plans.

Coverage varies by age and health condition. For instance, children and adolescents have a recommended schedule for their first shots. Adults have their own vaccination schedule. People who are immunocompromised or pregnant and older adults may be eligible for additional covered vaccines.

Older adults begin to qualify for additional covered vaccines based on age and risk of serious illness. For instance, the recommended age for getting the shingles vaccine for people whose immune systems are not compromised or suppressed is 50 and older. As people age, they also qualify for pneumonia, and - most recently - RSV vaccines, among others.

With health insurance, you shouldn't have cost sharing for vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP). Those vaccines protect you against:

• Anthrax

• Cholera

• COVID-19

• Dengue

• DTaP-IPV-Hib-HepB, a combination of diphtheria, tetanus, pertussis (whooping cough), poliovirus, Haemophilus influenzae type b (Hib), and hepatitis B

• DTaP/Tdap/Td, a combination of diphtheria, tetanus, and pertussis

• Ebola

• Hepatitis A

• Hepatitis B

• Herpes zoster (shingles)

• Hib

• Human papillomavirus (HPV)

• Influenza

• Japanese encephalitis

• Measles, mumps, and rubella (MMR)

• Measles, mumps, rubella, and varicella (MMRV)

• Meningococcal

• Orthopoxviruses (smallpox and Mpox)

• Pneumococcal

• Polio

• Rabies

• Respiratory syncytial virus (RSV)

• Rotavirus

• Tick-borne encephalitis

• Typhoid

• Varicella (chickenpox)

• Yellow fever

Potentially changing coverage for COVID-19 vaccines

The COVID-19 public health emergency ended on May 11, 2023. This resulted in changes to how COVID vaccines and services are covered by insurance plans and your out-of-pocket costs. COVID vaccines administered by an in-network healthcare professional are still free with insurance, but some plans do not cover COVID tests. Check with your insurance plan to confirm your COVID benefits.

The CDC continued to offer free COVID vaccines to uninsured and underinsured adults through its Bridge Access Program until August 2024. That means people without insurance or whose plans do not cover COVID vaccines may have to pay the full price - $200 or more - for the shots, along with administration costs.

Some manufacturers have programs that offer the COVID vaccine for free or at a reduced cost to uninsured and underinsured adults. Your state health department may have information about other options for free and low-cost vaccines. If you're a cash-paying consumer, you may be able to save on the COVID shot and other vaccines that you receive from a pharmacy (not a physician's office) with a free GoodRx coupon.

Children from uninsured or underinsured households can still receive COVID shots for free through the Vaccines for Children (VFC) program.

Vaccine coverage with no out-of-pocket costs

Private health insurance - including ACA marketplace plans - as well as Medicare and Medicaid must cover certain vaccines given by an in-network provider without charging coinsurance or copayments. Keep reading to learn more.

Vaccines covered by Medicare

If you have original Medicare, Part B and Part D cover most vaccines. Medicare Advantage plans must meet or exceed the benefits provided by original Medicare. Most Medicare Advantage plans have Part D prescription coverage, but some don't. It's important to note that some vaccines are not covered by Part D. And if your plan doesn't have Part D coverage, you'll need to buy a stand-alone plan to have those benefits.

Part B

Medicare Part B offers preventive care benefits, including no-cost coverage for the following vaccines:

• COVID

• Flu

• Hepatitis B (for individuals at high and intermediate risk)

• Pneumonia (pneumococcal)

Part B also covers vaccines that treat an injury or exposure to disease. This includes a tetanus shot if you step on a rusty nail and a healthcare professional recommends this vaccine. The same goes for a preventive rabies shot following a dog bite. But if you get a tetanus booster shot unrelated to injury or illness, that's covered by Part D.

Part D

Part D typically covers vaccines that are not covered by Part B. There is no cost sharing with Part D-covered vaccines, even if you get the vaccine from a healthcare professional who is outside your plan's network. You don't have to pay for vaccine administration either. (If you are charged a vaccine administration fee by an out-of-network provider, you can get reimbursed by your Part D plan.)

The vaccines covered under Part D include:

• Anthrax

• Cholera

• Dengue

• DTaP-IPV-Hib-HepB

• DTaP/Tdap/Td

• Ebola

• Hepatitis A

• Herpes zoster (shingles)

• Hib

• HPV

• Japanese encephalitis

• Meningococcal

• MMR

• MMRV

• Orthopoxviruses (smallpox and Mpox)

• Polio

• Rotavirus

• RSV

• Tick-borne encephalitis

• Typhoid

• Varicella (chickenpox)

• Yellow fever

Vaccines covered by Medicaid

As of Oct. 1, 2023, most adults who are covered by Medicaid can receive ACIP-recommended vaccines at no cost. These include:

• COVID

• Hepatitis A

• Hepatitis B

• Herpes zoster (shingles)

• HPV

• Influenza

• Meningococcal

• MMR

• Pneumococcal

• RSV

• Varicella (chickenpox)

Vaccines covered by private insurance

These vaccines are generally covered by private insurance plans:

• COVID

• DTaP/Tdap/Td

• Hepatitis A

• Hepatitis B

• Herpes zoster

• Hib

• HPV

• Influenza

• Meningococcal

• MMR

• Pneumococcal

• RSV

• Varicella (chickenpox)

Vaccines covered by Tricare

Military service members and their dependents are eligible for Tricare, which covers age-appropriate doses of vaccines as recommended by the CDC.

To get a covered vaccine at no cost, you will need to receive it from a Tricare-authorized healthcare professional or at a military hospital or clinic. Tricare covers some vaccines with no cost sharing at certain pharmacies.

Free or low-cost vaccines for children

Children under age 19 who are uninsured or underinsured qualify for the VFC program. Children enrolled in Medicaid or who qualify for Medicare coverage are also eligible. Even if the vaccines are free, you may be charged for an office visit and an administration fee.

Individuals enrolled in the Children's Health Insurance Program, known as CHIP, have vaccine coverage for preventable conditions and do not qualify for VFC benefits.

How to check if your insurance covers a vaccine

You can check whether your health insurance covers a vaccine by looking at your summary of benefits and coverage or contacting your plan. Make sure you know which vaccines are covered by your pharmacy benefit and which are covered at a hospital or doctor's office.

Be sure to get your covered vaccine from an in-network facility, healthcare professional, or pharmacy to avoid cost sharing. If you receive a vaccine while getting another healthcare treatment, you may be charged for an office visit.