Sponsors (3)
The bill temporarily expands no‑cost access to ACIP‑recommended vaccines across private and public programs through 2029—likely increasing vaccinations and preventing illness—while imposing short‑term costs, administrative burdens, and budget pressures for insurers, employers, and state programs, with uncertainty after the sunset date.
People covered by private group or individual plans, Medicaid/CHIP, and Medicare (including children in pediatric programs) will receive ACIP-recommended vaccines and administration without copays or deductibles through December 31, 2029.
Patients and communities may see higher vaccination rates and fewer vaccine-preventable illnesses because removing cost-sharing reduces financial barriers to vaccination.
Medicare beneficiaries and children in pediatric vaccine distribution programs gain temporary continuity of vaccine coverage for vaccines that were briefly revoked or changed after October 25, 2024.
Insured individuals, employers, and taxpayers may face higher short-term costs because insurers and employer plans must cover vaccines without cost-sharing, which could push up premiums or employer contributions.
States that use benchmark or benchmark-equivalent Medicaid plans must add adult vaccine coverage without cost-sharing, potentially straining state budgets or forcing offsets that affect other services.
State agencies, insurers, and providers will face additional administrative and compliance burdens to implement and coordinate the temporary coverage changes across programs.
Based on analysis of 2 sections of legislative text.
Requires group and individual market plans to cover, without cost‑sharing, vaccines ACIP‑recommended as of Oct 25, 2024, through Dec 31, 2029.
Official title: 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 Ronald Lee Wyden · Last progress September 18, 2025
Requires group health plans and individual and group market health insurance issuers to cover, without any cost‑sharing, immunizations that had an ACIP recommendation for the applicable person as of October 25, 2024 (including vaccines updated via approved supplemental BLA filed on or before that date). The coverage requirement is temporary: it applies on enactment for plan years that begin on or after enactment and ends December 31, 2029 (does not require doses given sooner than the minimum interval). The bill implements parallel requirements across the Public Health Service Act, ERISA, and the Internal Revenue Code to make the mandate apply broadly to regulated private health plans.