Are vaccines covered by health insurance? Most Affordable Care Act (ACA)-compliant major medical plans must cover seasonal flu shots and other recommended vaccines without charging a copay or coinsurance, but does short-term health insurance cover vaccines?
If you’re thinking about getting a flu shot, preparing for a trip, or have kids who need vaccinations, you may be curious how health insurance works with vaccines, and whether a short-term medical plan could help you get the care you want.
Short-term health plans do not generally include benefits for immunizations. In addition to excluding benefits for immunizations, short-term medical insurance does not cover pre-existing conditions, pregnancy care, or mental health services, in addition to other limitations and exclusions. Limiting the conditions covered and benefits offered helps short-term health insurance providers keep premiums low.
However, some short-term plans do include benefits for child immunizations and even some adult immunizations – it just depends on the type of plan you choose and your eligibility.
Short-Term Health Insurance Benefits for Child Immunizations
Short-term medical benefits for child vaccinations vary by state. Some plans provide what’s called “first dollar” coverage for immunizations for children up to the age of 18.* First dollar coverage means there is no deductible or copayment to meet before the plan pays benefits.
According to the Centers for Disease Control, on-time vaccination during childhood is critical because it helps establish immunity before children are exposed to serious, potentially life-threatening diseases. If you have children who need vaccinations and do not have access to an ACA-compliant major medical plan, short-term health insurance coverage may offer the health care benefits you want, depending on your eligibility.
A short-term health insurance plan through Vera typically includes access to the Aetna Open Choice® PPO network and benefits for:
- Doctor visits
- Urgent care
- Ground ambulance trips
- Emergency room care
- Home health care
- Child immunizations
- Physical therapy
- Diagnostic testing
- Emergency surgery
- Prescription drugs, in some states**
What Vaccines Do You Need?
Vaccines aren’t just for kids. Protection from childhood immunizations can wear off over time, and as an adult, you may be at a heightened risk for contracting a preventable disease depending on your age, career, or lifestyle.
The Centers for Disease Control (CDC) recommends that all adults get a seasonal flu vaccine every year, as well as the Tdap vaccine once if you did not get it as a child to protect against pertussis (whooping cough), plus a Td (tetanus, diphtheria) booster shot every 10 years. The CDC also recommends women get the Tdap vaccine each time they’re pregnant.
In addition to the seasonal flu shot and Td/Tdap vaccine, there are other vaccinations you may need depending on your age, lifestyle, and other factors. The CDC recommends the HPV vaccine for those aged 26 or younger to protect against the types of human papillomaviruses (HPV) that cause most cervical cancers and other health conditions. Additionally, many states require incoming college students to be vaccinated against certain diseases like meningitis.
Vaccine recommendations change with age. In addition to a Td/Tdap vaccine and seasonal flu shot, the CDC recommends vaccines that protect against shingles, pneumococcal disease, and pneumonia for most adults over 50.
Where to Get Affordable Vaccinations
You can still get certain vaccinations even if you don’t have health insurance, or if you can’t afford your plan’s out-of-pocket costs for vaccines. Visit your state health department website or locate a community health center to find vaccine resources near you. The CDC’s Vaccines for Children Program also provides vaccines to children under age 19 who meet certain criteria.
Short-term health insurance is not a good fit for everyone, but it might be for you. Learn more about your options and eligibility by visiting us online or chatting with a Vera Health pro at 888-499-1187.
*Benefits vary by state. Coverage differs in Nebraska, North Carolina, and Virginia.
**Covered services may be subject to waiting periods, visit limitations, deductible, coinsurance, or copays, and/or benefit maximums depending on the plan you purchase.
Short Term Medical coverage is not required to comply with federal market requirements for health insurance, principally those contained in the Affordable Care Act. Be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of pre-existing conditions or health benefits (such as hospitalization, emergency service, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services). If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage.