Sponsors (84)
The bill expands no-cost access to ACIP-recommended vaccines for many Americans through 2029—improving uptake and public health in the near term—while imposing near-term costs on payers, creating potential premium increases, limiting state flexibility, and leaving coverage uncertain after its 2029 expiration.
People with employer-sponsored or individual health plans will get ACIP-recommended vaccines without copays or deductibles through plan years ending in 2029, removing financial barriers and likely increasing vaccination rates and reducing preventable disease spread.
Children enrolled in Medicaid and CHIP will continue to receive pediatric vaccines recommended as of Oct 25, 2024 without cost-sharing through 2029, preserving access for low-income children.
Medicare beneficiaries (Part D) and retirees gain short-term clarity because the bill freezes treatment of vaccine recommendations as of Oct 25, 2024 for plan years through 2029, reducing immediate coverage uncertainty.
Insurers and employers will face higher near-term costs to cover vaccines without cost-sharing, which could be passed on to consumers via higher premiums or other cost-shifting.
Patients, providers, and payers face uncertainty after the policy expires on Dec 31, 2029 because the time-limited mandate may not be renewed or may change.
Patients (especially children and those needing multiple-dose series) may face confusion or unexpected out-of-pocket charges due to the exclusion for immunizations given during minimum intervals between doses.
Based on analysis of 2 sections of legislative text.
Requires group and individual market plans to cover ACIP‑recommended vaccines (as of Oct 25, 2024, plus FDA BLA supplements) with no cost‑sharing for plan years beginning before Jan 1, 2030.
Official title: To require coverage of certain immunizations recommended by the Advisory Committee on Immunization Practices under the Medicare program, the Medicaid program, the Children's Health Insurance Program, group health plans, and health insurance coverage.
Introduced September 18, 2025 by Frank Pallone · Last progress September 18, 2025
Requires group health plans and individual and group market health insurance issuers to cover, with no cost-sharing, immunizations that had an ACIP recommendation for the relevant person as of October 25, 2024 (including later FDA-approved BLA supplement updates) for plan years beginning on or after enactment through December 31, 2029. Exempts vaccines administered during a minimum interval established under existing law and adds the new coverage requirement into the statutory cross‑references that apply to ERISA plans and ACA-regulated insurers. Applies federal coverage rules across ERISA-governed employer plans and group and individual market issuers, inserts a related clerical table entry in ERISA, and is time-limited to plan years starting before January 1, 2030. No new appropriations or tax changes are created; the provision expands existing preventive‑service no cost‑sharing requirements for a defined set of vaccines for a limited period of time.