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 (birth through 18 years of age) can receive all of the necessary vaccinations according to the AAP’s recommended immunization schedule. These vaccines protect infants, children, and teens from 18 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 or Medicaid-enrolled

• Uninsured
• American Indian or Alaska Native
• Underinsured – Your child has health insurance, but it doesn’t cover any vaccines or covers only certain recommended vaccines, or has cost-sharing requirements (such as deductibles or copays) or a dollar cap for vaccines

Find out more about VFC eligibility.

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 37,000 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.

Important links:

• You can find a Federally-Qualified Health Center (FQHC) near you HERE.
• Find a map of rural health clinics (RHCs) in the United States HERE.
• To find your state or local health department, click HERE.
• Find more about the VFC program HERE.

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 for the visit. For example:

• • An administration 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 if other services were provided during the visit
  • Non-vaccine services, like an eye exam or blood test

Do I need to sign up for VFC?

No—parents do not need to enroll their child in the VFC program. Enrollment is handled by healthcare providers. At each visit, your child’s doctor will ask about insurance and Medicaid status to determine eligibility. You do not need to show proof of eligibility.

If your child is enrolled in Medicaid, is un- or underinsured, or is Native American or Alaska Native, they can receive no-cost, routinely recommended vaccines from a VFC provider.

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.

 

If your child (under 19 years old) needs 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 free or low-cost health insurance to children in families that do not 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 under age 19, including:

• Routine check-ups
• 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. Visit InsureKidsNow.gov or contact your state program for a list of participating healthcare providers in your area.

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. Find more about the costs of CHIP on Medicaid’s CHIP Program Cost Sharing web page.

How can I tell if my child qualifies 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 under 19  may qualify for Medicaid or CHIP based on the family’s income. Find out more at the CHIP website.
• Your child must be a U.S. citizen or a certain lawfully present immigrant to qualify for Medicaid or CHIP.
• If you apply for Medicaid coverage through your state agency, you’ll also find out if your child qualifies 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, which will then contact you about enrollment. You can also apply at your state’s Medicaid or CHIP agency.
• 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.

More resources:

• Healthcare.gov: Medicaid and CHIP
• InsureKidsNow.gov: Frequently Asked Questions

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, including Marketplace 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. Note that grandfathered health plans may not be required to provide this coverage, and $0 cost is not guaranteed in all cases. 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 infants, children, and adolescents.

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 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.

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 those who are eligible (see qualification requirements)
  • 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, the Inflation Reduction Act requires Medicare Part D Plans to cover all recommended vaccines at no cost to patients.

Important links:

• You can find a Federally-Qualified Health Center (FQHC) near you HERE.
• Find a map of rural health clinics (RHCs) in the United States HERE.
• To find your state or local health department, click HERE.

 

Medicaid

Medicaid is a joint federal and state health insurance program for low-income children, pregnant women, adults, seniors, and people with disabilities.

• Children

• Pregnant women
  • If you are pregnant and on Medicaid, the recommended flu, COVID-19, RSV, and Tdap vaccines are free

• 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 with 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, the Inflation Reduction Act requires Medicaid programs to cover all recommended vaccines at no cost to the patient.

Children’s Health Insurance Plan (CHIP)

In all states, CHIP provides free or low-cost health insurance, including recommended vaccines, 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, you will be offered programs you and your family qualify for. If it looks like anyone is eligible for Medicaid and/or CHIP, you can enroll for the program.

Important links:

• You can find a Federally-Qualified Health Center (FQHC) near you HERE.
• Find a map of rural health clinics (RHCs) in the United States HERE.
• To find your state or local health department, click HERE.

If you serve in the military or are a military dependent, you are eligible for TRICARE. Under TRICARE, vaccines are covered according to the recommended schedules:

• AAP’s child and adolescent vaccines
• AAFP’s adult recommended vaccines
• Vaccines recommended during pregnancy

Note that while the vaccines themselves are covered at no cost, you may have to pay copays or cost-shares for the office visit if you receive your vaccine from a provider rather than a participating network pharmacy. Travel vaccines are generally not covered unless you are an active-duty family member traveling on official orders.