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How do I pay for routine vaccines?

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Common question-girl flexing arm with doctor and parent

Most health insurance plans pay for or cover most of the cost of childhood vaccines. In addition, many children have vaccine coverage through Medicaid or the Children’s Health Insurance Program (CHIP). If you don’t have health insurance, your child can still get vaccinated for free or at a low cost.

If you have concerns about cost or don’t have insurance:

Key Information: Cost by insurance

Most private health insurance companies, Medicaid, and TRICARE cover the cost of vaccines. This is required by law in the Affordable Care Act (ACA).source: 1

  • If you have Medicaid: All recommended vaccines for your child are covered without any cost to you, for children through age 18 years. You may have a copay or fee, depending on what state you live in and the doctor your child sees to get vaccinated. Contact your state Medicaid office to learn more.source: 2
  • If you have military insurance (TRICARE): TRICARE covers routine vaccines for your child. Depending on your plan, you may have a copay or a fee for routine vaccines. Learn more about TRICARE vaccine coverage.source: 2
  • If you have private insurance: Most health insurance plans are ACA-compliant. This means there is usually no copay or coinsurance when a doctor in your network gives the vaccine. But be aware that insurance plans have up to 1 year from when the Advisory Committee on Immunization Practices (ACIP) recommends a new vaccine to cover it. Call your insurance plan to find out whether there’s any cost to you. Or look it up on your insurance portal.source: 2,source: 3
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Common Questions- child raising hands between two smiling parents

A Deeper Dive: What to do if you get a bill for a vaccine

ACA requires all routine vaccines to be free. However, there could be rare circumstances in which you may get a bill. One common reason is your child’s health insurance does not know the billing code your child’s doctor uses. For example, your child can get vaccines for free at TRICARE network doctors’ offices and pharmacies. If your child gets a vaccine outside of the TRICARE network, you may get a bill for the vaccine. If you have questions, contact your insurance company, or ask to speak to someone at your child’s doctor’s office.source: 4,source: 5

More information

Still have questions? Talk to your child’s doctor, nurse, or pharmacist.

Sources

  1. HHS: Fact Sheet: Celebrating the Affordable Care Act
  2. HHS: Immunization: How to Pay
  3. CMS: Affordable Care Act Implementation FAQs - Set 12
  4. American Academy of Pediatrics: 5 Reasons Why Parents Might Receive a Bill After a Well-Child Visit
  5. TRICARE: Immunizations
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