Your Insurance Might Not Cover The New COVID Vaccine This Time — Here's Why

There is understandably a lot of confusion right now. Here’s what experts want you to know.

There are more unknowns than certainties when it comes to the 2025-2026 COVID-19 vaccine due to recommendation changes from the Food and Drug Administration.

Last year, everyone 6 months and older could get the COVID shot and have it covered by insurance. This year, the FDA has limited access to people 65 and older and younger people with an underlying condition that puts them at high risk of severe disease. Those who aren’t in those groups could get a bill after getting the vaccine, or, in some cases, may be unable to get the shot at all.

It’s not clear how much a COVID shot would cost this fall if insurance doesn’t cover it, but according to Centers for Disease Control and Prevention data for the 2024-2025 shots, one dose for an adult can cost as much as $141.80. There could also be an administration fee on top of that, according to Dr. William Schaffner, a professor of preventive medicine in the Department of Health Policy at Vanderbilt University Medical Center in Nashville, Tennessee.

Shot eligibility could change after Sept. 18 and 19, when the CDC’s Advisory Committee on Immunization Practices (ACIP) meets to go over the FDA’s COVID vaccine recommendations.

“The ACIP meeting next week is going to be important ... they have COVID vaccine on the agenda, and I hope they vote clearly as to which populations for which they’re going to make a recommendation for COVID vaccine, which may not please me entirely, but at least we’ll have some clarity,” Schaffner told HuffPost.