The new RSV vaccine is generally covered by private insurance, Medicare, Medicaid, and the Vaccines for Children (VFC) program, with some conditions.
Insurance coverage for the RSV vaccine differs by age. The RSV vaccine is recommended for:
- infants younger than 8 months during the RSV season whose mothers did not receive the vaccine during pregnancy
- infants and children between 8 and 19 months of age who are at increased risk for severe RSV disease
- people who are 32 to 36 weeks pregnant during RSV season
- adults aged 60 years and above
By the way… did you read our recent post about whether COVID-19 is surging? Oopsie! We accidentally omitted the map of CDC’s COVID-19 wastewater surveillance estimates! We’ve fixed it now, if you want to check it out.
There are several paths to insurance coverage for vaccines based on enrollment in private insurance or federal programs. The RSV vaccine is recommended by the CDC Advisory Committee on Immunization Practices (ACIP) and is covered by private insurance (at least partially), Medicare, Medicaid/Children’s Health Insurance Program (CHIP), and the Vaccines for Children (VFC) program. Medicaid/CHIP and VFC are primarily based on income eligibility and Medicare is based on age eligibility. These programs mostly cover vaccines at no cost.
Various federal programs cover the RSV vaccine for infants and children who need it.
Pregnant people are typically fully covered for the RSV vaccine, except under some private plans or VFC where there might be a small cost.
Most people over age 65 receive health insurance through Medicare, which covers ACIP-recommended vaccines at no cost. RSV vaccine is covered under the Medicare Part D prescription drug plan. If you have Medicare but you don’t have Part D, you’ll have to check with your prescription drug benefit provider about coverage. Coverage is less clear for people with private insurance since the official guidance from CDC is that the decision should be based on a conversation with a clinician – some private insurance plans say this is not an official recommendation.
The retail cost of the RSV vaccine is estimated to be $180–$300. While there were some hurdles to getting the RSV vaccine covered initially, it is improving as more private insurance carriers provide coverage without copay and as health plans are becoming required to provide the vaccine at no cost in 2024. The biggest challenge is for adults between 60 and 65 who are underinsured or uninsured and have to pay a full or discounted rate out-of-pocket.
Stay safe, stay well!
Those Nerdy Girls
