Sponsors (73)
The bill greatly expands no-cost access to ACIP-recommended and updated vaccine formulations across private insurance, Medicaid/CHIP, and Medicare through 2029—improving public health and equity—but shifts costs onto taxpayers, states, and employers and limits flexibility for coverage of later vaccine recommendations.
People with private employer or individual insurance, Medicaid and CHIP enrollees, and Medicare beneficiaries will receive ACIP-recommended vaccines (including updated formulations approved via FDA BLA supplements) without cost-sharing through Dec 31, 2029, improving vaccine access and affordability.
Insurers and health plans get a clear statutory standard to cover updated vaccine formulations approved by FDA BLA supplements, reducing coverage disputes and administrative uncertainty for payers and providers.
Children in CHIP and vaccine-eligible pediatric patients must be covered for ACIP-recommended vaccines regardless of state coverage option, reducing pediatric coverage variability and protecting low-income children.
Taxpayers, state governments, and employers will likely face higher costs because insurers, Medicaid/CHIP, and group plans must cover vaccines without cost-sharing through 2029, which could raise insurance premiums, increase state budgets, or force employers to reduce benefits.
Tying coverage to ACIP recommendations in effect as of Oct 25, 2024 may exclude later ACIP recommendations or new vaccines, creating potential coverage gaps and confusion for patients and clinicians about what is covered after that date.
States required to include adult vaccine coverage in benchmark plans will have reduced flexibility in designing benchmark-equivalent coverage and may face added administrative complexity and costs.
Based on analysis of 2 sections of legislative text.
Requires no-cost-sharing coverage in group and individual plans for vaccines ACIP-recommended as of Oct 25, 2024, and FDA BLA-supplement updates, for plan years through 2029.
Introduced September 18, 2025 by Frank Pallone · Last progress September 18, 2025
Requires group and individual health plans and issuers to cover, without any cost-sharing, immunizations that had an Advisory Committee on Immunization Practices (ACIP) recommendation for the individual as of October 25, 2024, and formulations later approved via FDA biologics-license supplements. The coverage rule applies for plan years beginning on or after enactment and ending before January 1, 2030, and excludes doses given within legally established minimum intervals. Applies the same no-cost-sharing coverage requirement across the Public Health Service Act, ERISA-regulated group plans, the Internal Revenue Code treatment of group plans, and updates related Medicare Part D wording; it does not appropriate new funds but requires private plans and certain Medicare rules to follow the coverage standard through 2029.