The U.S. Centers for Disease Control and Prevention (CDC) and other health authorities recommend vaccination against many types of viral and bacterial illnesses. But, in most cases, vaccinations are not free (though there are programs available to those who qualify), and this raises an important question: Does health insurance cover vaccines? National vaccine attorney Leah V. Durant explains:

Health Insurance Covers Some (But Not All) Vaccinations

Generally speaking, health insurance coverage is available for vaccines—and most major health insurance companies pay for routine vaccinations as part of their standard coverage. For example, as the CDC explains, the following vaccines are usually covered by private health insurance:

  • COVID-19
  • Haemophilus influenzae type b (Hib)
  • Hepatitis A
  • Hepatitis B
  • Herpes zoster (shingles)
  • Human papillomavirus (HPV)
  • Influenza (flu)
  • Measles, mumps and rubella
  • Meningococcal
  • Pneumococcal
  • Respiratory syncytial virus (RSV)
  • Tetanus, diphtheria and pertussis
  • Varicella (chickenpox)

If you have private health insurance, when you schedule an appointment for an immunization, the CDC and Immunization Action Coalition (IAC) recommend requesting that your vaccination “be billed as the primary reason for your visit.” This is because vaccines are classified as preventive care, and “[i]n many cases, healthcare plans will cover the entire cost of the visit.” However, if you receive other services as well, your health insurance company may not provide full coverage.

Along with private health insurance, government healthcare plans provide full coverage for vaccinations in many cases as well. For example, Medicare Part B covers vaccination against COVID-19, hepatitis B (if you are at increased risk), influenza, and pneumococcal. It also covers vaccines “directly related to the treatment of an injury or direct exposure to a disease or condition, such as rabies and tetanus.” Medicare Part D covers CDC-recommended adult vaccines that are not covered under Part B, including herpes zoster and RSV.

If you have Medicaid coverage, or if your child is covered under the Children’s Health Insurance Program (CHIP), these programs provide “guaranteed coverage” for all CDC-recommended vaccines at no cost. If you have TRICARE, you should be able to obtain full coverage for all CDC-recommended vaccines as well.

What if You Don’t Have Health Insurance Coverage?

What if you don’t have health insurance coverage? Or, what if your health insurance doesn’t cover a particular vaccine that you want or need?

In this situation, you may have various options available. Of course, one option is to pay out of pocket if you can afford it. Before you pay out of pocket, however, you should make sure that your immunization truly isn’t covered. Health insurance companies are not always forthcoming about the costs they cover; and, in some cases, healthcare providers may be mistaken about what a patient’s health insurance covers and what it doesn’t.

If you don’t have health insurance coverage and you cannot afford to pay for a vaccine for yourself or your child, you may be eligible for a free immunization or for financial assistance under various state and federal programs. Some community organizations and non-profits sponsor vaccine drives and other no-cost or low-cost initiatives as well. Some examples of programs you may want to consider include:

Some drug companies offer no-cost and low-cost vaccines to qualifying individuals and families as well. If you need a particular vaccine (or if your child needs a particular vaccine) that you cannot afford, it may be worth visiting the manufacturer’s website to find out if it has a program available.

Does Health Insurance Cover Vaccine-Related Illnesses and Injuries?

Now that we’ve covered health insurance for vaccines, we should cover another important topic as well: What if you (or a loved one) is diagnosed with a vaccine-related injury or illness?

The answer to this question is much more complicated. While your health insurance might provide coverage, this is heavily dependent on the type of coverage you have—and, if you have a copay or deductible, you can likely expect to pay at least something out of pocket. If you don’t have health insurance coverage, your out of pocket responsibility could be far more.

But, health insurance isn’t the only option for covering the costs of vaccine-related injuries and illnesses. In some cases, these illnesses and injuries are covered under the National Vaccine Injury Compensation Program (VICP).

The VICP is a federal government program, similar to Medicare, Medicaid and TRICARE. However, unlike these programs, the VICP does not provide coverage when you need treatment (assuming your treatment needs are covered). Instead, the VICP pays compensation to eligible individuals and families who are coping with the effects of vaccine-related injuries and illnesses.

Seeking compensation under the VICP involves filing a claim in the U.S. Court of Federal Claims, which is also commonly known as the Vaccine Court. There are specific requirements you need to meet, so it is important to have an experienced vaccine attorney on your side. When you hire an experienced vaccine attorney to represent you, your attorney will be able to help you seek compensation for your present and future:

  • Medical costs
  • Other out-of-pocket costs
  • Lost earnings
  • Pain and suffering

If you have a VICP claim, you can hire a vaccine attorney to handle your claim at no cost. You can rely on your attorney to establish your eligibility, and you can work with your attorney to calculate the compensation you are entitled to recover. Since the VICP covers costs not covered by health insurance, you can—and should—file a claim regardless of any coverage that may be available to you.

Schedule a Free, No-Obligation Consultation with Vaccine Attorney Leah V. Durant

Do you need to know more about filing a claim for a vaccine-related injury or illness under the National Vaccine Injury Compensation Program (VICP)? If so, we invite you to schedule a free, no-obligation consultation at the Law Offices of Leah V. Durant & Associates. To request an appointment with vaccine attorney Leah V. Durant, please call 202-775-9200 or tell us how we can help online today.