Back to school time & coverage for vaccines

Ah, back to school talk already! Didn’t summer just begin? The kids may definitely not be thinking about school time, but parents sure may be. They are trying to figure out clothes shopping, supply shopping, but, what about their child’s vaccines? Are they up to date? Is there anything they need to be concerned with? What about for those families that worry about the cost of vaccines? According to a recent article about Back to School Vaccinations in the Wall Street Journal, different ways to cut costs or have them covered completely was discussed.

The article gave many options such as how to obtain free vaccines or how to avoid multiple office visit fees.

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The first thing discussed was the Affordable Care Act. Under this Act, many individuals or families who enroll in a new group or individual health plan on or after September 23, 2010, can get free vaccines. That means no co-payment, deductible or co-insurance as long as you use an in-network provider. And some health plans that existed before that date are subject to the rule as well, according to HealthCare.gov, the website of the Department of Health & Human Services.

The vaccines must be those recommended by the Advisory Committee on Immunization Practices (a part of the Centers for Disease Control and Prevention). They include vaccines for hepatitis B; measles, mumps, rubella and varicella (MMRV); and influenza, or flu.

“The majority of large vaccines [that people with new insurance] get are covered by insurers with no cost sharing,” says Susan Pisano, spokeswoman for America’s Health Insurance Plans, a national trade association representing the health-insurance industry. “It’s required now.”

But if you had health insurance prior to September 23, 2010 and your plan is exempt from the rule (ask your provider if you’re not sure), you’ll likely have to pay for vaccines. However, there are some ways to avoid paying additional costs. For instance, try to schedule any vaccines at the same time as an office visit so you don’t have a separate co-pay. Schedule all vaccines for one appointment if possible, even if they are due at different times throughout the year.

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In addition, with some insurers and medical providers, you may be able to schedule vaccine-only visits that don’t require a co-pay. Among the vaccines that may qualify: the flu shot and second or third doses of the HPV vaccine, says Lance Rodewald, Director of the Immunizations Services Division at the CDC. Check with your insurer and medical provider for specifics.

Separately, if you have an existing high-deductible health plan, vaccinations can get costly since the actual cost of the shots will be covered by you until you meet the deductible, says Herschel Lessin, a Pediatrician in Poughkeepsie, N.Y.

In some cases, it may be cheaper to go to a community clinic. Most offer the flu shot and sometimes other vaccines. For instance, according to the clinic at the Berkeley, California Public Health Clinic, tetanus and measles vaccines each cost $17. Hepatitis A and B vaccines are free, but you must pay for an office visit ranging from $39 to $91 depending on the patient if you don’t qualify for California’s Health Access Program, which helps people find affordable health care based on age, income and other requirements.

People with children who are uninsured or underinsured have other options. A child may be eligible for the Vaccines for Children Program, a federal program that gives free vaccinations to those age 19 and younger if they’re Medicaid-eligible, American Indian, an Alaska Native or lack health insurance.

You only have 3 years to file a claim.

It's important that you start the process as soon as possible.
See If You Have a Case

Such children, as well as those who have insurance, which doesn’t cover vaccinations, can get the vaccines at federally qualified health centers or rural health centers. For more information, go to the National Association of Community Health Centers website. The CDC’s Mr. Rodewald says 48% of children will qualify for the Vaccines for Children program.

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