{"id":82700,"date":"2025-08-21T13:52:08","date_gmt":"2025-08-21T13:52:08","guid":{"rendered":"https:\/\/www.newsbeep.com\/uk\/82700\/"},"modified":"2025-08-21T13:52:08","modified_gmt":"2025-08-21T13:52:08","slug":"for-some-fall-covid-shots-may-come-with-copays-or-no-coverage-at-all","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/uk\/82700\/","title":{"rendered":"For some, fall Covid shots may come with copays \u2014 or no coverage at all"},"content":{"rendered":"

If you\u2019re in good health and plan to get a Covid shot this fall, you might end up with an unwelcome surprise: a bill.<\/p>\n

The Food and Drug Administration is expected to approve the next round of Covid shots soon, but only for a smaller, high-risk group<\/a> \u2014 adults 65 and older and people with underlying health conditions. The Centers for Disease Control and Prevention is likely to follow suit, limiting its recommendation on who should get the shots to the same groups. (The CDC currently recommends Covid vaccination for everyone 6 months and older.)<\/p>\n

The change, experts say, could affect what insurers are willing to cover for everyone else who doesn\u2019t fall under a high-risk group<\/a>. <\/p>\n

By law, most health insurance plans are required to fully cover vaccines recommended by the CDC and its outside advisory committee, the Advisory Committee on Immunization Practices (ACIP). <\/p>\n

For those who don\u2019t fall under the CDC\u2019s new recommendations, experts say coverage would depend entirely on their insurance \u2014 with some deciding to fully cover the shot, others requiring a copay and some not covering it at all.<\/p>\n

Without insurance, a Covid shot can cost up to $140, according to the CDC\u2019s vaccine price list<\/a>.<\/p>\n

\u201cIt could very well get confusing,\u201d said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Nashville, Tennessee, and an adviser to ACIP. Whether you\u2019re able to get a free shot \u201cmay greatly depend on which company with which you have your insurance.\u201d<\/p>\n

Who can get a Covid vaccine?<\/p>\n

Under the expected recommendations from the CDC, healthy children and adults won\u2019t be barred from getting the Covid vaccine, said Dorit Reiss, a vaccine policy expert at UC Law San Francisco.<\/p>\n

\u201cIt\u2019s legal to give a vaccine off-label,\u201d Reiss said, referring to when a doctor prescribes a drug for something different than what the FDA approved it for, \u201cand insurance companies can choose to cover them.\u201d<\/p>\n

A spokesperson for AHIP, a health insurance industry trade group, said that every individual insurer will come up with its own policy following the CDC\u2019s final guidance. <\/p>\n

The CDC\u2019s list of conditions<\/a> that put a person at high risk for severe illness from Covid is extensive, and includes cancer, heart disease and lung conditions as well as physical inactivity and depression.<\/p>\n

Insurers also take into account clinical recommendations from outside medical organizations, like the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, the spokesperson said.<\/p>\n

On Tuesday, the AAP, which has expressed its disapproval for Health Secretary Robert F. Kennedy Jr.\u2019s vaccine decisions, released its own recommendations supporting Covid vaccinations for children.<\/p>\n

Most people are also unlikely to notice changes to their insurance coverage overnight \u2014 if there are any, according to the AHIP spokesperson.<\/p>\n

For private plans \u2014 including Obamacare plans \u2014 any changes stemming from ACIP meetings could likely only be implemented in the next benefit year, typically Jan. 1, the spokesperson said. That means it\u2019s possible that people who get a shot before then might be covered. Medicare and Medicaid plans are required to follow ACIP recommendations immediately upon the CDC director\u2019s signature. Covid vaccines have also already been factored into insurers\u2019 plans for this year.<\/p>\n

In an emailed statement, a spokesperson for Blue Cross and Blue Shield said that \u201ceach independent Blue Cross and Blue Shield plan will make their own coverage decisions.\u201d<\/p>\n

A spokesperson for Aetna said pregnant women and children will be able to get the new Covid booster this fall and winter with no copay. <\/p>\n

Healthy adults who get Aetna coverage through their jobs might have different coverage, the spokesperson added.<\/p>\n

It\u2019s unclear if that means they\u2019ll have to pay or not.<\/p>\n

Covid and flu shots<\/p>\n

The changes could affect people planning to get their Covid and flu vaccines at the same time.<\/p>\n

Schaffner, of Vanderbilt, said some people choose to get their Covid and flu shots at the same time, but there are concerns that some could be turned away due to the anticpated change in recommendations.<\/p>\n

He added that misinformation about who is able to get the Covid shots may also discourage people from getting either vaccine.<\/p>\n

\u201cI think we have to reassure people, particularly those at high risk, that the vaccine will be available to them,\u201d he said.<\/p>\n

Rick Gates, Walgreens\u2019 chief pharmacy officer, said its pharmacists usually determine whether a patient has coverage before a vaccine is administered. <\/p>\n

Because of this, it\u2019s unlikely anyone would be hit with a surprise bill due to new CDC recommendations, he said, adding that the patient would first be told whether the vaccine is fully covered, a copay is required or the patient must pay entirely out of pocket. <\/p>\n

Gates said that people are already coming in for their flu shot, but many seem to be holding off on the Covid shot until the updated version is available. During last year\u2019s respiratory virus season peak, he said, more than 50% of patients got both shots at once \u2014 a number that has grown over the past two to three years.<\/p>\n","protected":false},"excerpt":{"rendered":"If you\u2019re in good health and plan to get a Covid shot this fall, you might end up…\n","protected":false},"author":2,"featured_media":82701,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[43],"tags":[102,2960,56,54,55],"class_list":{"0":"post-82700","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthcare","8":"tag-health","9":"tag-healthcare","10":"tag-uk","11":"tag-united-kingdom","12":"tag-unitedkingdom"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts\/82700","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/comments?post=82700"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts\/82700\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/media\/82701"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/media?parent=82700"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/categories?post=82700"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/tags?post=82700"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}