Summary

Requires group health plans, private health insurers, Medicare, Medicaid, and CHIP to cover — and not charge cost sharing for — immunizations that had an ACIP recommendation for the individual as of October 25, 2024. The rule applies to plan years that include or begin on/after enactment and generally runs through the end of 2029 / early 2030 for affected provisions. The bill adds related rules into existing federal statutes governing public health, employee benefit plans, the tax code, and federal health programs.

Key Points

• Requires no-cost coverage for immunizations that had an ACIP recommendation for the individual as of Oct 25, 2024.
• Applies to group health plans, health insurance issuers, Medicare, Medicaid, and CHIP.
• Effective for plan years during enactment or beginning on/after enactment; many provisions expire by Dec 31, 2029 or Jan 1, 2030.
• Adds provisions to the Public Health Service Act, ERISA, the Internal Revenue Code, and amends parts of the Social Security Act.
• Ties coverage specifically to ACIP recommendations in effect on a single cutoff date (Oct 25, 2024).
• Eliminates patient cost sharing (deductibles, copays, coinsurance) for covered vaccines during the covered period.
• Does not create a new, explicit appropriation in the text; payers and programs must absorb implementation and coverage costs per existing funding rules.
• Requires administrative updates by plans, issuers, and federal/state program offices for claims, benefit design, and beneficiary communications.
• Includes pediatric and program-specific timelines for Medicaid/CHIP provisions that generally run through the end of 2029.

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