No one should skip vaccinations because they can’t pay for them. There are several programs available to families (people of all ages) in the United States who can’t afford to pay for vaccines.
Paying for Children’s Vaccines (Birth through Age 18)
Vaccines for Children (VFC) Program
The Vaccines for Children (VFC) program is a federally-funded program that provides vaccines to children whose parents or guardians may not be able to afford them. This helps ensure that all children and teens can receive all of the necessary vaccinations according to the CDC’s recommended immunization schedule. These vaccines protect children and teens from 16 serious diseases.
Who Is Eligible for the VFC Program?
Any child that is younger than 19 years of age and meets one of the following requirements:
- American Indian or Alaska Native
- Underinsured (Your child has health insurance, but the insurance policy doesn’t cover any vaccines or doesn’t cover certain recommended vaccines).
Where Can My Child Get VFC Vaccine?
Your child can get VFC vaccine from a healthcare provider who is enrolled with the VFC Program. Nationally, there are more than 40,000 healthcare providers enrolled. If your child is eligible for VFC, ask your child’s doctor if they are a VFC provider. If your child’s doctor isn’t a VFC provider, you can take your child to one of the following places to get VFC vaccines: public health clinics, federally-qualified health centers (FQHC), or rural health clinics (RHC).
Underinsured children are only eligible to receive VFC vaccines at federally-qualified health centers or rural health clinics.
What are the costs for the VFC vaccines?
While there is no charge for the vaccines given by a VFC provider to eligible children, healthcare providers may charge other costs with the visit. For example:
- A fee to administer each shot (However, VFC vaccines cannot be denied to an eligible child if the family cannot afford the fee).
- A fee (copay) for the office visit
- Non-vaccine services, like an eye exam or blood test
How do I sign up my child up for VFC?
Children's Health Insurance Program (CHIP)
If your children (up to 19 years old) need health insurance, they may be eligible for the Children’s Health Insurance Program (CHIP). CHIP is administered by states, according to federal requirements. CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP also covers pregnant women. Each state offers CHIP, and works closely with its state Medicaid program.
What health services for my child are covered under CHIP?
CHIP benefits are different in each state, but all states provide comprehensive health insurance for children up to age 19, including:
- Routine check-ups
- Doctor visits
- Dental and vision care
- Inpatient and outpatient hospital care
- Laboratory and X-ray services
- Emergency services
Some specific benefits may be different from state to state. Check with your state program for more information.
How can I find a healthcare provider that accepts CHIP?
Each state Medicaid and CHIP program has its own provider network. Contact your state program for a list of healthcare providers.
What are the costs of CHIP?
Routine “well child” doctor and dental visits are free under CHIP. But there may be co-pays for other services. Some states charge a monthly premium for CHIP coverage. The costs are different in each state, but you won’t have to pay more than 5% of your family’s income for the year.
How can I see if my children qualify for CHIP and if so, how do I enroll them in the program?
You can apply for/enroll your children in CHIP at any time of year. If you qualify, your children’s health coverage can start right away.
Each state program has its own rules about who qualifies for Medicaid or CHIP, but in most states:
- Children up to age 19 with family income up to $49,200 per year (for a family of four) may qualify for Medicaid or CHIP. In many states, family income can be even higher and children can still qualify.
- Your children must be U.S. citizens or certain lawfully present immigrants to qualify for Medicaid or CHIP.
- If you apply for Medicaid coverage through your state agency, you’ll also find out if your children qualify for CHIP.
You have three ways to find out if your children are eligible for CHIP, and if so, to enroll them:
- Call 1-800-318-2596 (TTY: 1-855-889-4325)
- Fill out an application through the Health Insurance Marketplace (Healthcare.gov website). If it looks like anyone in your household qualifies for Medicaid or CHIP, they will send your information to your state agency who will then contact you about enrollment.
- To find information about the Medicaid and CHIP programs in your state, go to Learn About Programs in Your State (through the InsureKidsNow.gov website) or call 1-877-KIDS-NOW (1-877-543-7669). When you call the free and confidential hotline, you’ll be connected to someone in your state who can help you learn whether your children may qualify and help you enroll them.
The Affordable Care Act (ACA)
The Affordable Care Act (ACA), also referred to as “Obamacare” aims to provide health insurance to Americans while reducing the overall costs of healthcare. Visit the Health Insurance Marketplace (Healthcare.gov) to find health insurance for yourself and your family.
Under ACA, most health plans must cover certain preventive services, including recommended vaccinations for children and teens, at no cost to you (without charging a co-payment or co-insurance). This is true even if you haven’t met your yearly deductible. These services are free only when delivered by a doctor or other provider in your children’s health plan’s network. (See recommended vaccine schedules for children and preteens/teens).
Paying for Vaccines for Adults and Pregnant Women (19 years old and older)
The Affordable Care Act (ACA)
The Affordable Care Act (ACA), also referred to as “Obamacare”, aims to provide health insurance to Americans while reducing the overall costs of healthcare. Visit the Health Insurance Marketplace (Healthcare.gov) to find health insurance for yourself and your family.
Under ACA, most health plans must cover certain preventive services, including ACIP-recommended vaccinations for adults and pregnant women at no cost. The vaccines should be given by an in-network healthcare provider without charging a co-payment, co-insurance or a deductible. (See recommended vaccine schedules for adults including pregnant women).
Medicare is the federal health insurance program for people who are 65 or older; certain younger people with disabilities; and people with end-stage renal disease.
Medicare Part B
Medicare Part B (covers certain doctors’ services, outpatient care, medical supplies, and preventive services) will pay for:
- Flu vaccines
- Pneumococcal vaccines
- Hepatitis B vaccines for people at increased risk of hepatitis
- Vaccines directly related to the treatment of an injury or direct exposure to a disease or condition, such as rabies and tetanus
Medicare Part D
A Medicare Part D Plan (that adds prescription drug coverage) lets you know how each adult vaccine will be covered on their formulary. Part D plan formularies must include all commercially available vaccines (except those covered by Part B). A new vaccine may not specifically appear in the formulary, but the plan may still cover the vaccine. Contact your Medicare Part D plan to find out about coverage for adult vaccinations.
A Medicare Part D Plan or Medicare Advantage Plan (Part C) that offers Medicare prescription drug coverage may also have coverage for:
- Shingles vaccine
- MMR vaccine
- Tdap vaccine
Medicaid and Children's Health Insurance Plan (CHIP)
Medicaid provides healthcare for millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. States have different income eligibility rules.
Young adults up to 21 years old may be eligible for Medicaid. Teens/young adults who have “aged out” of foster care can be covered under Medicaid until they reach 26 and there is no income limit.
Children’s Health Insurance Plan (CHIP)
In all states, CHIP provides low-cost health insurance, including ACIP-recommended vaccinations, to children up to 19 years old in families that earn too much money to qualify for Medicaid. In some states, CHIP also covers pregnant women.
Learn more about the Medicaid and CHIP programs.
EPSDT provides comprehensive and preventive health care services, including ACIP-recommended vaccinations, for people under age 21. (Anyone 18 years old or younger that is Medicaid-eligible can get vaccines through the federally-funded Vaccines for Children program).
Some specific Medicaid benefits may be different from state to state. While most state Medicaid programs cover at least some adult vaccines, not all offer every ACIP-recommended vaccine for adults.
Fill out an application at healthcare.gov. When you finish the application, they will tell you you which programs you and your family qualify for. If it looks like anyone is eligible for Medicaid and/or CHIP, they will let the state agency know so you can enroll.
If you serve in the military or are a military dependent, you are eligible for TRICARE. Under TRICARE, vaccines are covered according to the CDC recommended schedules.