Where can I get vaccinated? Does insurance cover vaccinations? How much does an out-of-pocket vaccination cost?
As of September 2010, the Health Care Reform Law requires insurance companies to cover certain preventive treatments, including general vaccinations, although in reality there are many “yes, but….” subtleties and some “grandfathered” insurance plans are exempt from this law. Always ask in advance.
According to the U.S. Department of Health and Human Services, the vaccines covered by insurance are:
- Routine shots for things like measles, polio or meningitis.
- The flu (influenza) vaccine.
- Pneumonia vaccines.
- Vaccines that ensure healthy pregnancies.
- Hepatitis A and B vaccines.
- Human papillomavirus (HPV) vaccines.
Yet there are exceptions. Some insurance plans are exempt from the new rules, so always ask your provider. Also, even if the service is covered under your plan, it is quite likely that you will be required to use an in-network or participating provider, and you may have a co-pay or other charge. If you don’t use a participating provider, you will quite probably have to pay the full charge. (We know a new dad who got a preventive shot at his pediatrician’s recommendation, and he paid full freight, something like $250, because he didn’t ask in advance.)
The short answer: ask. Ask if it is covered. Ask how much it costs, and ask how much you will pay. The two answers are likely to be different: if a dose of HPV vaccine is billed at $185 and your co-pay is $20, you want to know that. Get these figures in writing, and get the name of the person who gave you these figures. If you have to go back to someone after the fact, a paper trail helps.
You may need to ask both the provider (who’s giving the shot), and the payer (the insurance company, most likely). Know before you go – so you don’t get an unpleasant surprise.
if you receive a vaccine outside of your insurance network, you may be charged.
Pharmacies and walk-in clinics offer convenient and sometimes affordable immunization alternatives for those without insurance or with providers that do not cover vaccines. However, in
many states, such as New York, you must be at least 18 years old to receive a vaccine at a pharmacy. Inquire what the law is in your state. For a full listing of vaccines that ClearHealthCosts put together, visit the “advanced search” page, type the name of the vaccine in the search box, click “all regions” on the region tab, then stand back. Here’s what we found for flu shots and put in the database. Here’s what we found for HPV vaccines.
Not every location offers all of the vaccines listed in the links above. For example, most Rite Aid pharmacies in New York offer three vaccines:
- The flu (influenza) vaccine at $29.99
- The shingles (Herpes Zoster) vaccine at $200
- The pneumonia (pneumococcal) vaccine at $150
Most Duane Reade pharmacies in New York offer the same vaccines at the following prices:
- The flu vaccine at $31.99
- The shingles vaccine at $219.99
- The pneumonia vaccine at $79.99
Most CVS pharmacies in New York are only offering the flu vaccine at $31.95, while other CVS locations are not offering any vaccines.
If the vaccination you need is not offered by a local pharmacy or if you have a child who requires vaccination, you can visit a walk-in immunization clinic for similar prices. Unlike pharmacies, walk-in clinics will give immunizations to people under age 18. Most Department of Health walk-in clinics in the state of New York offer the following vaccines:
- Hepatitis B vaccine
- Hepatitis A vaccine
- Diphtheria, tetanus & pertussis combination vaccines, including Tdap and DTaP
- Tetanus (Td) vaccine
- Measles, mumps & rubella (MMR) combination vaccine
- Pneumonia (pneumococcal) vaccine
- Human papillomavirus (HPV)
- Meningococcal vaccine
- Influenza vaccine
- Haemophilus influenzae (Hib) vaccine
- Polio vaccine
- Varicella vaccine
Walk-in centers and primary-care centers, as well as retail clinics like the ones in drugstores, also offer vaccinations. Prices vary widely. It is always best to ask how much a trip will cost, in addition to specific vaccination prices – especially if you’re uninsured. ClearHealthCosts has compiled a list of prices for walk-in and similar providers for those looking.
For a state-by-state list of clinics that offer vaccinations, visit www.vaccines.gov. For an easy-to-understand article about the government recommendations about vaccines for adults, click here to go to mayoclinic.com, one of our favorite sites for medical information.
Prices can vary widely, as we found in a quick survey that’s here on the blog under the title “So, how much does a flu shot cost? $9? $12? $15? $30?” And opinions about effectiveness can also vary widely. Here’s a post about that.