Private medical insurance
All Marketplace plans and most private plans are required to cover certain vaccines, without copayment or co-insurance, when obtained from an in-network provider. This applies even to patients who have not met their annual deductible. The doses, ages, and populations to which they are recommended vary. Vaccines against the following diseases are usually covered by health insurance:
- Hepatitis A
- Hepatitis B
- Shingles ( shingles )
- Human papilloma virus
- Measles, mumps, rubella
- Meningococcal vaccine
- pneumococcal vaccine
- Tetanus, diphtheria, whooping cough ( pertussis )
Check with your health insurance provider for the details of your coverage. Under the Affordable Care Act, health insurance with children’s coverage now allows adult children to be added or kept on the same parent’s policy until age 26.
Per CDC recommendations, adolescents and young adults ages 16 to 23 now have the option to get the serogroup B meningococcal vaccine. Health insurance plans are required to cover vaccines in the new recommendations the following year of validity. Check the details with your insurance provider to see if you will have to pay anything for this vaccine.
Medicare Part B will pay for the following:
- Influenza (flu) vaccinesexternal icon
- The pneumococcal vaccinesexternal icon
- Hepatitis B vaccinesexternal icon for people at higher risk of contracting hepatitis.
- Vaccines are directly related to the treatment of an injury or direct exposure to a disease or condition such as rabies and tetanus.
Medicare Part D plans to identify the vaccines that are covered in their list of covered prescription drugs (formulary). Part D plans’ lists of covered prescription drugs must include all commercially available vaccines (except those covered by Part B). New preventive vaccines may not be specifically listed, but may still be covered by the plan. Contact your plan to find out about your coverage external icon.
Medicare Part D, or the Part C of the Medicare Advantage Plan that offers coverage through Medicare for prescription drugs, may also cover the following:
- The herpes zoster (shingles) vaccineexternal icon
- The MMR vaccine
- The Tdap vaccineexternal icon
Most state Medicaid agencies cover at least some of the vaccines for adults, but some may not offer any vaccines at all. For more information, check with your state Medicaid agency external icon.
If you are in the military or a dependent of a military member, you are eligible for TRICARE health insurance. TRICARE covers vaccines according to the CDC-recommended immunization schedule external icon.