Sponsors (3)
The bill significantly expands no-cost access to ACIP-recommended and updated vaccines across Medicaid, CHIP, private insurance, and Medicare through 2029—improving public health and lowering patient costs in the near term—while raising short- and medium-term fiscal and administrative costs and leaving beneficiaries vulnerable to coverage changes after the 2029 sunset.
Medicaid enrollees, CHIP children, people with employer or individual coverage, and many Medicare beneficiaries will have ACIP-recommended vaccines (including formulations approved via supplemental BLAs) covered with no cost-sharing for plan years through December 31, 2029, reducing out-of-pocket vaccine costs and improving access.
Coverage explicitly includes vaccine formulation updates approved by supplemental Biologics License Applications (e.g., strain updates), so people receive up-to-date vaccine protection without cost-sharing.
Medicare Part D beneficiaries keep coverage continuity when an ACIP-recommended vaccine is later revoked: plans must treat the vaccine as covered based on the most recent recommendation in effect before revocation for plan years through 2029.
Taxpayers, federal/state budgets, and private plan sponsors (including small businesses) may face higher costs from mandated no-cost vaccine coverage, which could raise premiums, employer health costs, or public spending.
The protection is time-limited through December 31, 2029, creating the risk that people who rely on no-cost vaccine coverage will face cost increases or coverage gaps after that date.
States that use benchmark Medicaid-equivalent plans must revise benefits to eliminate cost-sharing for these vaccines, imposing administrative burdens and potential state budget adjustments.
Based on analysis of 2 sections of legislative text.
Requires plans and issuers to cover, with no cost-sharing, vaccines ACIP-recommended as of Oct 25, 2024, (including certain BLA updates) for plan years through 2029.
Introduced September 18, 2025 by Ronald Lee Wyden · Last progress September 18, 2025
Requires group and individual health plans, employer-sponsored (ERISA) plans, and related federal tax and Medicare rules to cover, without any cost-sharing, vaccines that were recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP) for an individual as of October 25, 2024. The coverage mandate applies to plan years beginning on or after enactment and ending before January 1, 2030, and includes vaccines updated via supplemental approvals to certain licensed biologics if those supplements were approved by that date. Excludes doses given earlier than the minimum interval set by existing public health rules, and adds matching provisions to ERISA and the Internal Revenue Code while making a conforming change to Medicare law. The requirement creates a temporary, across-the-board no-cost-share vaccine coverage obligation for private plans and some federal programs for the specified set of ACIP-recommended vaccines through 2029.