COVID-19 vaccines are free if you’re enrolled in Medicare, whether you are enrolled in Original – or traditional – Medicare or a Medicare Advantage plan. That means you will not pay a deductible, coinsurance, or copay for the vaccine itself, administration of the vaccine, or the visit for the vaccine (as long as the visit was not for other reasons).[efn_note]“Medicare Billing for COVID-19 Vaccine Shot Administration” CMS.gov Accessed April 4, 2024[/efn_note] For example, if you got a COVID-19 vaccine during a visit you had to follow-up on your blood pressure, you would still pay a coinsurance for your visit but the vaccine and its administration would be free.
All Medicaid enrollees are also guaranteed free COVID vaccines through September 30, 2024. Enrollees with full Medicaid coverage will continue to be able to access free COVID vaccines after that date, although access to free COVID vaccines for limited-benefit enrollees will vary by state. (Examples of limited-benefit Medicaid programs include people who are eligible only for family planning benefits, or only tuberculosis-related benefits.)[efn_note]“Coverage and Payment of Vaccines and Vaccine Administration under Medicaid, the Children’s Health Insurance Program, and Basic Health Program” (see Table 3) Centers for Medicare & Medicaid Services. February 2024.[/efn_note]
Under most private health plans, your COVID vaccine is free to you if you remain in-network. However, there could be costs for getting your vaccine through an out-of-network provider. If you have grandfathered private health insurance (meaning the plan was already in effect when the ACA was signed into law in March 2010), the policy can impose out-of-pocket costs for covered vaccines[efn_note]“Insurance Coverage of Updated COVID-19 Vaccines: A Cheat Sheet” KFF.org. Sep. 22, 2023[/efn_note] (Grandfathered plans are not required to cover vaccines at all.)[efn_note]“Access to Preventive Services without Cost-Sharing: Evidence from the Affordable Care Act” Assistant Secretary for Planning and Evaluation, HHS. January 11, 2022.[/efn_note]
There is no guarantee that uninsured adults will be able to access free vaccines. However, many children will be covered as part of the Vaccines for Children Program. This includes children 18 and younger who are eligible for Medicaid, are uninsured, are underinsured – if they get their vaccination at a Federally Qualified Health Center (FQHC) or Rural Health Center (RHC), or who are American Indian or Alaskan Native (AI/AN). It is possible that there could be administrative fees for these vaccines, although no child can be denied a vaccine if they cannot afford to pay.[efn_note]“Vaccines For Children (VFC) Program Information for Providers” CDC.gov Accessed April 5, 2024[/efn_note]