Will insurance cover Covid-19 vaccines during the fall season?
As we approach 2025, there is growing uncertainty about the coverage of COVID-19 vaccines in employer health plans. Previously, under the Public Health Emergency (PHE) that ended in May 2023, COVID-19 vaccines were generally covered at 100% under preventive care in most employer plans when administered by in-network providers [2]. However, recent changes and conflicting federal recommendations, especially those influenced by newly constituted federal leadership, have caused confusion about the specific coverages for COVID-19 vaccines this fall [1][3].
Vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) must be covered without cost sharing by employer-sponsored plans. However, the new ACIP and altered federal leadership have created uncertainty about which COVID-19 vaccines qualify [1][3]. In contrast, influenza vaccines remain mandated for coverage without cost sharing. However, multi-dose flu vaccines with thimerosal are now recommended against [1].
Employers and employees should closely monitor updates from their health plans and official CDC and HHS guidance to confirm the coverage status and vaccine recommendations for 2025 [2][3]. It's worth noting that the Moderna and Pfizer-BioNTech Covid vaccines were recommended for anyone at least 6 months old last year [4]. However, the FDA's approval for these vaccines comes with restrictions. For instance, Moderna's Spikevax Covid vaccine is fully approved by the FDA, but approval is restricted to adults 65 and older, and people from 6 months through 64 years old who are at increased risk of developing a serious case of Covid [5].
The situation is further complicated by the fact that some states may require a call to the physician to send over a prescription for the vaccine if ACIP hasn't yet recommended covid shots for the fall [6]. This year, the Centers for Disease Control and Prevention recommends the vaccines for adults 19 and older [7].
Despite the confusion, it's important to note that the Pfizer's Comirnaty Covid vaccine is still approved or authorized for people 6 months of age and older without any restrictions based on risk factors for Covid [4]. Health care professionals can help people determine whether they qualify for the shot based on health conditions [8].
In a video announcement in May, Robert F. Kennedy Jr., Health and Human Services Secretary, cited safety risks for young people and pregnant people as justification for changes in COVID-19 vaccine recommendations [9]. However, FactCheck.org analysis found that Kennedy's claims about vaccine safety for pregnant people and children were misrepresented [10].
As we navigate these uncertainties, it's crucial for parents to understand that if a child qualifies for the vaccine under the "shared clinical decision-making" model and a health care provider recommends it, the child can receive it, and it should be covered without cost sharing [11].
Without insurance coverage, people could owe hundreds of dollars for the shot [12]. It's also worth noting that fewer sites may offer vaccinations if far fewer people are expected to be vaccinated [3].
As the situation evolves, it's essential to stay informed and consult with healthcare professionals to make informed decisions about vaccination.
- In the evolving landscape of health policies, it's crucial for employers and employees to remain vigilant about updates from their health plans and official guidance from the CDC and HHS to confirm the coverage status and vaccine recommendations for 2025.
- Despite some uncertainties regarding the coverage of COVID-19 vaccines in employer health plans, influenza vaccines, on the other hand, remain mandated for coverage without cost sharing.
- Health care professionals can help individuals determine their eligibility for the COVID-19 vaccine based on medical conditions, including chronic diseases, mental health, and other health and wellness factors.
- In the midst of confusion surrounding COVID-19 vaccine recommendations, it's worth noting that some CBD products may offer potential benefits for managing anxiety and improving mental health.
