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Health Care Reform Eliminates the Out-of-Pocket Cost of Vaccines for Many Immunizations


By Randall Gerber October 28, 2015 Posted in: Family Health , Article

Because of 2010's Affordable Care Act (ACA), many Americans now benefit from the widespread lower cost of vaccines, as well as greater access to them. This "right to bare arms" -- quite different from the one granted by our country's founders well over 200 years ago -- has millions of U.S. residents rolling up their sleeves to receive a range of immunizations as part of their health coverage.

Under the ACA, immunizations are included in general coverage, and there are no out-of-pocket costs (deductibles or co-pays) as long as the vaccinations are administered by an in-network provider, which is a physician or medical practice that is part of the network your insurance plan covers.

Are you taking advantage of the lower costs ACA reform offers? If you're not aware of what's available, you might be missing out on meaningful, well-priced health care for your family -- including your children.

Good for You

Immunizations are important for youth and adults to:

  • Prevent infectious diseases. This includes such conditions as measles, the flu, and whooping cough.
  • Avoid lost work time. An annual bout with the flu can cost you up to two weeks of downtime, and even a week of missed school for your child is too much. Consider also the affect on families where both parents work and one must stay home to care of a sick child.
  • Lower overall health care costs. An estimate from the National Conference of State Legislatures says that every dollar spent on immunizations saves you an additional $16 in avoided health costs down the road.

Here's a quick overview on which covered immunizations are now more widely available because of the newly lowered cost of vaccines. Both children and adults are covered for:

  • Hepatitis A and hepatitis B.
  • Measles, mumps, rubella (MMR).
  • Meningitis.
  • Human papillomavirus (HPV).
  • Pneumonia.
  • Varicella (a virus that causes chicken pox and shingles).
  • The flu.

Children are also covered for polio and rotavirus (the most common cause of diarrhea in young children). Be aware of the recommended immunization schedule for children, as determined by the U.S. Department of Health and Human Services (HHS).

Adults should get the Tdap shot (for tetanus, diphtheria, and pertussis) every 10 years, while pregnant women need a Tdap shot per pregnancy. The HHS also offers a breakdown on adult immunizations.

Be aware that so-called travel vaccines, shots required for traveling overseas, are generally not covered under these preventive services.

Defining In-Network

Vaccines can be administered at a doctor's office, some pharmacies, and even sometimes at your workplace or at health departments. To get access to lower-cost immunizations available under the ACA, make sure the location you select is in-network. You can certainly receive immunizations at out-of-network places or from professionals not in your network, but the costs will be higher because you might be required to pay out-of-pocket fees. To find out which medical professionals are in your network, call the customer service number for your health plan. Many times, health care plans even list their network of providers on their website.

Armed with this information, you'll know you have the choice -- both for yourself and for your family -- to get the immunizations you and your loved ones need. Don't hesitate: It's time to roll up your sleeve and bare your arm for better health.

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