Paying for Vaccines

The Vaccines for Children (VFC) program is a federal program that provides vaccines to children whose parents or guardians may not be able to afford them. This helps to make sure that all children and teens (through 18 y.o.) 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:

• Medicaid-eligible
• Uninsured
• 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 Vaccines?

Your child can get VFC vaccines 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 a different VFC provider. In addition to pediatricians and family physicians, other healthcare providers that might participate in the VFC program include Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), pharmacies, urgent care clinics, and school-based clinics.

Underinsured children are only eligible to receive free VFC vaccines at a FQHC or RHC.

For help finding a VFC provider or for other questions regarding the Vaccines for Children program, contact your state or local health department or call 1-800-CDC-INFO (1-800-232-4636) for help in English and Spanish.

You can also use this “Find a Health Center” widget to find a FQHC near you or click here to find a U.S. Google map of RHCs.

What are the costs for the VFC vaccines?

While there is no charge for the routinely recommended vaccines given by a VFC provider to eligible children, your provider may charge other costs with the visit. For example:

• • A fee to give each shot (However, they cannot refuse to vaccinate your child if you are unable to pay these fees.)
  • A fee (copay) for the office visit
  • Non-vaccine services, like an eye exam or blood test

Do I need to sign up for VFC?

If your child is enrolled in Medicaid or if they are Native American or Alaska Native, they can get free routinely recommended vaccines from a VFC provider.

If not, you will be asked if your child has health insurance that covers vaccines. If not, your child should be eligible for free vaccines from VFC.

For questions about the Vaccines for Children program, ask your doctor, contact your state or local health department, or call 1-800-CDC-INFO (1-800-232-4636) for help in English and Spanish.

Download CDC”s VFC Fact Sheet for Parents – Available in English and Spanish.

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 run by the states, according to federal requirements. CHIP provides low-cost health insurance to children in families that earn too much money to qualify for Medicaid. In some states, CHIP also covers pregnant women.

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
• Vaccinations
• Doctor visits
• Prescriptions
• 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” visits 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 – whose family’s income is 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), 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 copay or coinsurance). 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).

The Affordable Care Act (ACA), also referred to as “Obamacare”, helps Americans get health insurance. 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 CDC’s routinely 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-pay, co-insurance or a deductible.

See which vaccines are recommended for adults.

Pregnant women are recommended to get flu and Tdap vaccines during every pregnancy to protect against flu and whooping cough (Tdap) during each pregnancy to protect both themselves and their babies from serious illness.

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
• COVID-19 vaccines
• 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 Plans

As of January 1, 2023, Medicare Part D Plans cover all vaccines at no cost to patients.

You can also use this “Find a Health Center” widget to find a Federally-Qualified Health Center (FQHC) near you or click here to find a U.S. Google map of rural health clinics (RHCs).

Medicaid

Medicaid is a joint federal and state health insurance program for low-income:

• Children
• Pregnant women
  • If you are pregnant and on Medicaid, the recommended flu and Tdap vaccines MAY be free. This depends on the state you live in. To find out the answer, ask your healthcare provider or contact your state’s Medicaid office.
• Adults
  • 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 by Medicaid until they reach 26 years old and there is no income limit.

• Seniors
• People with disabilities

Even though the federal government pays a portion of the costs, Medicaid is run by the states. Each state’s program is a little different and has different income eligibility rules. On October 1, 2023, all Medicaid plans will have to cover all vaccines at no cost to the patient.

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.

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.

You can also use this “Find a Health Center” widget to find a Federally-Qualified Health Center (FQHC) near you or click here to find a U.S. Google map of rural health clinics (RHCs).

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.