Does My Health Insurance Cover Vaccines?

As a parent, you want to do everything you possibly can to ensure your child is healthy. One of the best ways to do that is to make sure your child is vaccinated. Vaccines are the most effective way to prevent your child from being infected with a variety of diseases that are known to have harrowing, lasting, and even life-threatening effects.

Vaccines will protect your child from various illnesses, including the measles, mumps, rubella, chicken pox, hepatitis, and pertussis; conditions that are considered highly dangerous and have been the cause of death for thousands of children and adults across the globe. In addition to protecting your child, vaccines also help to prevent others from being affected from potentially life-threatening diseases; babies who are too young to be vaccinated, those who have a weakened immune system, such as cancer patients, and the elderly. By having your child vaccinated, you are aiding it what is referred to as “herd immunity”; in other words, if those around individuals who cannot receive vaccinations or who have a weak immune system are vaccinated, than those individuals will not be exposed to infectious, potentially deadly diseases.

While vaccines are the most effective way to prevent the contraction and spread of infectious diseases, it’s likely that you are wondering how to pay for them. Read on to find out more about health insurance coverage for vaccines.

Health Insurance and Vaccines

The majority of health insurance plans do cover the cost of vaccines. Under the Affordable Care Act (ACA or Obamacare), private health insurance plans are required to provide coverage for preventive care; including vaccinations. Insurance plans that are purchased through the Health Insurance Marketplace must offer coverage for the following vaccines:

• Diphtheria
• Hepatitis A
• Hepatitis B
• Herpes Zoster
• Human Papillomavirus (HPV)
• Influenza (the flu)
• Measles
• Mups
• Meningococcal
• Pertussis
• Pneumococcal
• Rubella
• Tetanus
• Varicella (chickenpox)

It’s important to note, however, that while private health insurance plans that are purchased through the Marketplace to offer coverage for vaccines, insurance plans are different and not all will offer the same type of coverage. Additionally, if you have an older or limited plan, you may not be covered for all of the recommended vaccines. With that said, it’s important that you contact your health insurance company before you arrange to have vaccinations administered.

You can view your policy details on your health insurance company’s website; or, for more accurate information, contact your carrier directly. You may overlook information on the website or may not know how to read the information properly. When speaking with your insurer, make sure that you find out the specific details of your policy, including any out-of-pocket expenses that you may be required to cover, such as co-pays and deductibles.

What if Your Health Insurance Doesn’t Cover Vaccinations?

If you have health insurance but your plan doesn’t include coverage for vaccines, there are options available that can help you pay for the expense. The Vaccines for Children (VFC) program offers vaccinations at no cost to medical care providers who service children who are eligible. All children that are younger than the age of 19 are eligible for the VFC program if they are eligible for Medicaid, if they do not have health insurance, or if they are a Native American a Native Alaskan.

Important Points to Note

Whether you have health insurance that covers vaccines, make sure that when you are scheduling your appointment, you request that it be billed as the primary reason for your appointment. Most health insurance plans will cover the entire cost of your appointment, which means you won’t have to pay for any other services that are offered during your visit, such as a physical exam. Of course, you should make sure that you confirm if your visit will be covered by contacting your health insurance provider before you schedule your appointment.

Additionally, it’s important that you find out if your plan requires you to see an in-network doctor. If it does and you schedule an appointment with an out-of-network healthcare professional, you could end up having to pay for the entire cost of your visit out of your own pocket.

Summing It Up

Vaccinations are the most effective way to protect your child, yourself, and others from infectious diseases. If you have health insurance, it’s likely that your plan will cover the cost of vaccinations; however, do make sure that you contact your health insurance plan before you schedule an appointment for the service so that you are fully aware of your coverage and what payments, if any, you will be responsible for.

If you do not have insurance and you would like to purchase a private plan through the Marketplace, contact a reputable insurance agent to find out what options are available to you.