Will my doctor prescribe the COVID vaccine if I’m not in the FDA-approved populations?

This will depend on your doctor. Prescribing a drug for something outside of its FDA approval is referred to as an “off-label prescription.” This is legal, and about 20% of prescriptions are off-label.[efn_note]“ Off-Label Drugs: What You Need to Know ” Agency for Healthcare Research and Quality. Accessed Sep. 8,. 2025[/efn_note] If your doctor won’t write the prescription and your pharmacy won’t give you the shot without a prescription, you can contact your health plan to confirm whether the vaccine is covered, and if so, see if they can provide any guidance for how you could obtain it.

Where can I get a COVID vaccine if my health plan won’t pay for it?

If your health plan won’t pay for a COVID vaccine, first check with your state insurance department to ensure that the plan is allowed to refuse the coverage. If so, you can check with your state health department to see if there are any public health clinics in your area where you can get a low-cost or free COVID vaccine. Alternatively, you can choose to pay out of pocket for the vaccine at your local pharmacy, but be aware that the cost without health insurance will likely be at least $140 for an adult dose.[efn_note]“ Current CDC Vaccine Price List ” (Adult COVID-19 vaccine price list). Centers for Disease Control and Prevention. Sep. 1, 2025[/efn_note] (And as is always the case when you pay out-of-pocket for something that’s not covered by your health plan, the money you spend will not count toward your deductible or your out-of-pocket maximum.) If you have flexible spending account (FSA) or health savings account (HSA) funds available, you can use that pre-tax money to pay for a COVID vaccine.[efn_note]“ Publication 502, What are medical expenses? ” Internal Revenue Service. Accessed Sep. 9, 2025[/efn_note]

When will ACIP make vaccine recommendations for 2025-2026?

ACIP is meeting September 18 and 19, to discuss recommendations for several vaccines, including COVID, Hepatitis B, measles, mumps, rubella, varicella (MMRV) and Respiratory Syncytial Virus (RSV).[efn_note]“ Meeting of the Advisory Committee on Immunization Practices ” Centers for Disease Control and Prevention. Aug. 29, 2025[/efn_note] Senator Bill Cassidy, M.D. (R-LA), who chairs the Senate Health, Education, Labor, and Pensions (HELP) Committee, had called for the meeting to be postponed, and noted that if it went ahead (as was the case), any recommendations should be “rejected as lacking legitimacy,” due in part to the “current turmoil in CDC leadership.”[efn_note]“ Cassidy Calls for Vaccine Committee Meeting to be Postponed Following CDC Departures ” U.S. Senate HELP Committee. Aug. 28, 2025[/efn_note] But no changes had been made to the ACIP meeting schedule as of Sep. 8.

Home > FAQs > Can you get the updated COVID-19 vaccine – and will your health insurance cover the cost?

Can you get the updated COVID-19 vaccine – and will your health insurance cover the cost?

Author: Louise Norris | Date Posted: October 22, 2025

The Centers for Disease Control and Prevention (CDC) has finalized new COVID vaccine recommendations that differ from past years’ recommendations. If you’re wondering whether you’re eligible for the updated COVID vaccine, how to get it, and whether your health insurance will cover the cost, you’re not alone.

Here’s what you need to know, and the steps you can take if you’d like to get an updated COVID shot this fall:

Who is eligible to receive the updated COVID-19 vaccine?

Under the new recommendations from the CDC’s vaccine advisory group (called ACIP), anyone at least six months of age can get the updated COVID vaccine. But the recommendation calls for “shared clinical decision-making” with a doctor, pharmacist, or other medical professional, to determine whether a person should get the shot.¹,²

Like the flu shot, COVID-19 shots are updated each year to protect people against the strains of the virus that are currently circulating. In previous years, the CDC simply recommended that everyone six months and older get the updated vaccine.³ The addition of “shared clinical decision-making” or “individual decision making” is new for 2025.

What you can do:

Contact your pharmacy or doctor’s office to ask about getting an updated COVID vaccine. Find out whether the pharmacy is requiring a prescription as proof of “shared decision-making” with your doctor.
Contact your state’s health department to see if your state has done anything to ensure widespread access to COVID vaccines. Depending on where you live, your state might have taken action to make it easier for pharmacists to vaccinate anyone who requests the shot.⁴

See if your health plan covers the COVID-19 vaccine

It’s likely that your health plan is continuing to provide broad coverage of the updated COVID vaccine. The trade organization that represents most American health plans has clarified that “Health plans will continue to cover all ACIP-recommended immunizations that were recommended as of September 1, 2025, including updated formulations of the COVID-19 and influenza vaccines, with no cost-sharing for patients through the end of 2026.”⁵

But that should not be taken as a guarantee, and consumers should still confirm their coverage before getting the vaccine.

What you can do:

Contact your health plan to find out whether you have coverage for the updated vaccine, and any specific coverage rules that the plan might have. Take notes if you do this over the phone, including the name of the person you spoke to and a reference number for the call.
If your pharmacy has told you that you’ll need a prescription or proof of a consultation with your doctor, ask your health plan if you’ll have any out-of-pocket costs for the necessary office visit or telehealth visit.
To have coverage for the COVID vaccine, your plan will likely require you to use an in-network pharmacy or medical office. So be sure you know where those options are.

Helpful background information:

Most health plans are required to cover the full cost of vaccines recommended by the CDC,⁶ as part of the ACA’s preventive care coverage.
The addition of “shared clinical decision-making” in the updated CDC recommendations means that “it is possible that some consumers may face challenges” in having coverage for the updated shots.⁷
But health plans can also provide vaccine coverage beyond the minimums set by CDC recommendations. As noted above, most health plans have committed to providing coverage of the updated 2025-26 COVID shots.⁵
In addition, some states have taken action to require state-regulated (non-self-insured) health plans to continue to cover COVID vaccines, adding an additional layer of coverage security.⁷

Where can I get the COVID vaccine if my health plan won't pay for it?

As long as your health plan covers recommended vaccines (meaning it’s an ACA-compliant individual or employer-sponsored plan, or a grandfathered plan that voluntarily covers vaccines), you’ll continue to have coverage for the updated COVID vaccine under the most recent CDC recommendations.¹ Your health plan might require you to consult with your doctor or other medical provider before obtaining the vaccine, due to the “shared decision-making” component of the recommendation,⁷ but it’s not an option for these plans to simply not cover the vaccine at all.

However, if your health plan is grandfathered or is not subject to the ACA’s coverage requirements (examples include fixed indemnity plans, short-term health plans, and non-insurance plans such as health care sharing ministry plans), it doesn’t have to provide vaccine coverage – although these plans can voluntarily cover the cost of vaccines. If your plan doesn’t cover the COVID vaccine, you can reach out to your state health department to see if there are any programs in your area where you can access a free or discounted vaccine. If you have children, they may be eligible for a free vaccine through the Vaccines for Children program.¹

If you’re not eligible for a free or low-cost vaccine, you can still go to your doctor or local pharmacy to get the shot, although you’ll have to pay for it yourself.

How much does the COVID vaccine cost without insurance?

If you don’t have insurance that covers the COVID vaccine, the price will depend on where you get the shot. It will likely be in the range of $150 to $200,⁸ although some nationwide pharmacies have a list price of up to $250, depending on which vaccine you get.⁹

However, you may find that you can get a lower cash price by using a coupon.¹⁰

Will Medicare and Medicaid still pay for the COVID vaccine?

Yes, both Medicare and Medicaid cover the updated COVID vaccine.¹¹¹

For Medicare beneficiaries, the COVID vaccine is covered by Medicare Part B.¹² So beneficiaries have coverage for the COVID vaccine even if they don’t have Medicare Part D drug coverage.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written hundreds of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.