Some individuals may be able to receive flu vaccination at no or little cost.
- Children aged 6 months through 18 years who enroll in new group plans or individual private health policies, when provided by an in-network provider
- Adults aged 19 years and older who enroll in new group plans or individual private health policies, as of September 23, 2010, when provided by an in-network provider
- Individuals with Medicare Part B (Medical Insurance)
Children aged 6 months through 18 years are eligible for free flu vaccine, but may have to pay an administrative fee, if they meet at least one of the following.
- Medicaid eligible: A child who is eligible for the Medicaid program. (Refers to children who have health insurance covered by a state Medicaid program.)
- Uninsured: A child who has no health insurance coverage.
- American Indian or Alaska Native: As defined by the Indian Health Care Improvement Act (25 U.S.C. 1603
- A child who has private health insurance but the coverage does not include vaccines,
- a child whose insurance covers only selected vaccines,
- or, a child whose insurance caps vaccine coverage at a certain amount. Once that coverage amount is reached, the child is considered as underinsured. Underinsured children are eligible to receive vaccine only through a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC).
If your child meets one of the eligibility criteria listed above, the vaccine must always be provided free of charge. This means that no one can charge a fee for the vaccine itself.
However, each state immunization provider has been granted the ability to charge what is called an “administrative fee.” An administrative fee is similar to a patient’s co-pay, in that it helps providers offset their costs of doing business. The amount of the administrative fee differs from state to state.
More information on how to get help paying for your child’s flu vaccine.
Individuals already enrolled in group plans or individual private policies
Beginning in the plan year or policy year that starts after March 2, 2011, all adults 19-49 years of age will be eligible to receive seasonal flu vaccine with no cost-sharing (copayments, fees, deductible, or coinsurance) requirements when provided by an in-network provider.