Will coverage for Covid-19 vaccinations be included in health insurance policies this autumn?
The landscape of Covid-19 vaccine recommendations has shifted, affecting individuals across various age groups and health conditions. Here's what you need to know.
Last year, the Moderna and Pfizer-BioNTech vaccines were recommended for anyone aged 6 months and older. However, recent changes announced by Health and Human Services Secretary, Robert F. Kennedy Jr., have narrowed down the eligibility criteria.
Now, Novavax's Nuvaxovid and Moderna's mNexspike are restricted to people aged 65 or older and those between 12 and 64 with underlying health conditions that put them at higher risk of developing severe Covid.
This change is due to safety risks for young people and pregnant individuals, as Kennedy cited in a video in May. It's important to note that there's no similar allowance for pregnant people, but pregnancy is one of the underlying medical conditions that increases the risk of severe Covid, according to the CDC.
The Advisory Committee on Immunization Practices (ACIP) hasn't yet voted on Covid vaccine recommendations for this fall. Most private health plans are required by law to cover recommended vaccines without charging their members once they are recommended.
However, the narrower recommendations from different HHS agencies might result in some health plans declining to pay for certain categories of people to get certain vaccines. This could be a notable hurdle, especially for people looking for pediatric doses of a Covid vaccine.
Without insurance coverage, people could owe hundreds of dollars for the shot. However, if a parent wishes a child to get a Covid vaccine and a health care provider recommends it, the child can receive it under the "shared clinical decision-making" model, and it should be covered without cost sharing.
The FDA recently granted full approval to Moderna’s COVID vaccine (Spikevax) for children aged 6 months through 11 years who are at increased risk of severe disease. An updated vaccine formulation is expected for the 2025-2026 respiratory season. This suggests vaccines remain available and covered under plans for at-risk children despite the shift away from universal recommendation.
Employer health insurance plans are expected to cover COVID-19 vaccines for children and pregnant individuals this fall at 100% when administered by in-network providers. Coverage for COVID vaccines continues under preventive care benefits despite the end of the federal Public Health Emergency in 2023.
In sum, coverage continues but routine recommendation for healthy children and pregnant individuals has been withdrawn, making vaccination a clinical decision rather than a universal mandate this fall. Health care professionals can help people determine whether they qualify for the shot based on health conditions.
It's already a challenge to convince people they need annual Covid shots, and shifting guidelines may make it tougher, some public health experts warn. Additionally, pharmacists' authority to administer vaccines depends on several factors, and since ACIP hasn't yet recommended covid shots for the fall, that could create a speed bump in some states.
It's crucial to stay informed about these changes and discuss any concerns with healthcare professionals. The ongoing pandemic requires vigilance and adaptability, and understanding the latest developments in vaccine recommendations is an essential part of that.
- As for the insurance aspect, most private health plans are required to cover recommended vaccines without charging their members once they are recommended.
- Without insurance coverage, people could owe hundreds of dollars for the Covid vaccine shot.
- However, if a parent wishes a child to get a Covid vaccine and a health care provider recommends it, the child can receive it under the "shared clinical decision-making" model, and it should be covered without cost sharing.
- Coverage for COVID vaccines continues under preventive care benefits despite the end of the federal Public Health Emergency in 2023.
- Employer health insurance plans are expected to cover COVID-19 vaccines for children and pregnant individuals this fall at 100% when administered by in-network providers.
- In the realm of science, the landscape of Covid-19 vaccine recommendations has shifted, affecting individuals across various age groups and health conditions.
- The CDC considers pregnancy as one of the underlying medical conditions that increases the risk of severe Covid.
- The FDA recently granted full approval to Moderna’s COVID vaccine (Spikevax) for children aged 6 months through 11 years who are at increased risk of severe disease.
- The Advisory Committee on Immunization Practices (ACIP) hasn't yet voted on Covid vaccine recommendations for this fall.
- Now, Novavax's Nuvaxovid and Moderna's mNexspike are restricted to people aged 65 or older and those between 12 and 64 with underlying health conditions that put them at higher risk of developing severe Covid.
- This change is due to safety risks for young people and pregnant individuals, as Kennedy cited in a video in May.
- An updated vaccine formulation is expected for the 2025-2026 respiratory season.
- It's important to note that there's no similar allowance for pregnant people, but pregnancy is one of the underlying medical conditions that increases the risk of severe Covid, according to the CDC.
- It's crucial to stay informed about these changes and discuss any concerns with healthcare professionals.
- The ongoing pandemic requires vigilance and adaptability, and understanding the latest developments in vaccine recommendations is an essential part of that.
- Without a universal recommendation, vaccination becomes a clinical decision rather than a mandate.
- Health care professionals can help people determine whether they qualify for the shot based on health conditions.
