Despite shifting federal guidance, health insurance companies have vowed to cover the COVID-19, flu and other recommended vaccines, a trade group said.
America’s Health Insurance Plans said its members will fully cover COVID, flu and other vaccines recommended by a Centers for Disease Control and Prevention vaccine panel as of Sept. 1, 2025. The vaccines will be covered “with no cost-sharing for patients through the end of 2026,” AHIP said.
Most large employers that provide health insurance benefits for workers and their families will continue to cover Food and Drug Administration-approved vaccines, said James Gelfand, president and CEO of the ERISA Industry Committee.
The timing of the insurers’ pledge is key because the vaccine recommendations could soon change.
Health and Human Services Secretary Robert F. Kennedy Jr. fired all members of the Advisory Committee on Immunization Practices, a key vaccine panel that makes recommendations for COVID-19 and other vaccines, and appointed new members.
The newly-appointed vaccine panel will meet Thursday, Sept. 18, and Friday, Sept. 19, to discuss recommendations for the measles, mumps and rubella; hepatitis B and COVID-19 vaccines, according to a preliminary agenda.
Why are doctors and patients concerned about getting vaccines?
The federal policy shifts on vaccines worry doctor groups, elected officials and some patients who have reported difficulties getting new COVID-19 shots.
In August, the FDA approved new versions of the COVID-19 shots for the fall that tightened access to the immunizations for some populations. Only those over 65 and people with existing health problems will be recommended for the COVID-19 vaccine.
But Kennedy’s reconstituted vaccine panel has yet to make a formal recommendation on the new COVID-19 shots, which has snarled access in some states where pharmacists can’t administer vaccines without a vaccine panel recommendation.
What are states doing to get COVID shots to kids, adults?
California, Colorado, Oregon, Nevada and Washington have taken action on their own in an attempt to ensure residents can get a COVID-19 shot.
Sen. John Hickenlooper, D-Colorado, said vaccine policy changes have created “a lot of friction, confusion.”
He said a federal Vaccines for Children program that administers shots to uninsured and low-income children is “at a standstill” and pharmacies in several states are unsure if they can administer vaccines.
Speaking during a Senate hearing Wednesday on the ouster of former CDC Director Susan Monarez, Hickenlooper also said insurance plans are uncertain about the federal guidance.
“Many insurance plans defer to federal recommendations to determine coverage of vaccines, leaving many families with bills that can range into the hundreds of dollars, just for vaccines,” Hickenlooper said. “We’ve got a real problem to navigate.”
Are there exceptions to insurance vaccine coverage?
While insurance plans don’t have to cover vaccines not included in the vaccine panel’s recommendation, most appear willing to do so.
Private health insurance plans expect to cover COVID-19 vaccines at no cost for all patients, including children, pregnant women and healthy individuals, AHIP said in a statement to USA TODAY.
However, policies can differ for some types of insurance plans. Employers who provide health insurance benefits for the bulk of working-age Americans might choose to enact restrictions.
If the vaccine panel imposes restrictions for certain populations, employer health insurance plans might choose to charge a co-pay, Gelfand said. Or patients might need a prescription or consultation with a doctor or other medical provider.
“This is the responsible, science-driven, non-political approach,” Gelfand said.
A KFF poll published Aug. 1 found 40% of adults said they will “definitely” or “probably” get a COVID-19 vaccine shot. Of those who intend to get vaccinated, 62% said they are worried insurance won’t cover the cost of the vaccine.
Contributing: Mary Walrath-Holdridge
This article originally appeared on USA TODAY: Insurance will cover vaccines amid RFK Jr. turmoil
