Protecting Free Vaccines Act
This bill requires private health insurance, employer plans, Medicare, Medicaid, and CHIP to provide coverage for all vaccines recommended by federal health advisers as of October 25, 2024, with zero out-of-pocket costs. Through the end of 2029, patients would pay no copays or deductibles for these shots, including updated versions approved by the FDA. Health plans and government programs would be required to maintain this free coverage even if federal advisory committees later revoke or scale back their recommendations for those vaccines.
What this bill touches.
Who it helps · who it burdens.
Who it helps
- Enrollees in private group and individual health insurance plansReceive guaranteed coverage with zero out-of-pocket costs or cost sharing for all vaccines recommended by the Advisory Committee on Immunization Practices as of October 25, 2024, through plan years starting before January 1, 2030.
- Medicare Part D enrolleesReceive guaranteed coverage with no cost sharing for vaccines recommended as of October 25, 2024, even if that recommendation is subsequently revoked, through plan years starting before January 1, 2030.
- Medicaid and CHIP beneficiariesReceive mandatory coverage for recommended vaccines and their administration without copayments or cost sharing under state Medicaid programs (including pregnant individuals and those in benchmark benefit plans) and CHIP through December 31, 2029.
Who it burdens
- Health insurance issuers and group health plan sponsorsMust cover and cannot impose any cost sharing for immunizations recommended by ACIP as of October 25, 2024 (including FDA-approved updates) through plan years starting before January 1, 2030.
- Medicare prescription drug plan sponsorsMust cover vaccines recommended as of October 25, 2024, without cost sharing, even if ACIP revokes the recommendation, through plan years starting before January 1, 2030.
- State Medicaid and CHIP agenciesMust provide coverage for all vaccines recommended as of October 25, 2024, and their administration without cost sharing, including for pregnant beneficiaries and under benchmark benefit packages, through December 31, 2029.
- Vaccines for Children program participating providersProhibited from dropping pediatric vaccines recommended as of October 25, 2024, from the Vaccines for Children distribution schedule through December 31, 2029, regardless of any subsequent recommendation removals.
The provisions, in plain language.
Requires private group and individual health insurance plans to cover, without any out-of-pocket costs, all vaccines recommended by the CDC's Advisory Committee on Immunization Practices as of October 25, 2024 (including FDA-approved updates), through plan years starting before January 1, 2030.
Requires Medicare prescription drug plans to continue covering, without cost sharing, any vaccine recommended by the advisory committee as of October 25, 2024, even if that recommendation is later revoked, through plan years starting before January 1, 2030.
Requires state Medicaid programs to cover all vaccines recommended by the advisory committee as of October 25, 2024, and their administration, through December 31, 2029.
Guarantees Medicaid coverage for recommended vaccines and their administration for pregnant individuals.
Prohibits the federal government and healthcare providers from dropping any vaccine recommended as of October 25, 2024, from the Vaccines for Children distribution program through December 31, 2029.
Bars state Medicaid alternative and benchmark benefit plans from charging copayments, deductibles, or other cost sharing for recommended adult vaccines.
Requires Children's Health Insurance Program (CHIP) plans to provide free coverage, with no cost sharing, for all vaccines recommended by the advisory committee as of October 25, 2024, through December 31, 2029.