New Act Mandates Zero-Cost Vaccines Across Private Insurance, Medicare, and Medicaid Until 2030

The new Protecting Free Vaccines Act of 2025 is straightforward: it requires most major health plans to cover a specific list of vaccines at zero cost to the patient. This mandate applies to vaccines recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP) as of October 25, 2024. For anyone with private insurance (group or individual plans), Medicare Part D, Medicaid, or CHIP, this means no deductibles, no copays, and no other cost-sharing for these specific preventative shots until January 1, 2030. Essentially, the bill takes the existing rule that mandates free coverage for preventative services and locks in a specific set of ACIP-recommended immunizations across the board.

The Health Insurance Cost-Sharing Freeze

If you have private insurance through your employer or the marketplace, this bill is designed to keep money in your pocket when you get a shot. The bill amends the Public Health Service Act, ERISA, and the Internal Revenue Code to ensure that group health plans and issuers must cover these specific ACIP-recommended immunizations without cost-sharing. This is a big deal for public health, as eliminating the $20 copay or the need to meet a $2,000 deductible is often the difference between someone getting a vaccine and skipping it. For instance, if you’re a busy parent trying to get the latest recommended vaccine for yourself or your older kids, this means one less bill and one less financial hurdle to worry about. The catch? This protection has an expiration date: January 1, 2030.

Medicare and Medicaid Get Fixed Coverage

The bill also tightens up coverage rules for public programs, but with a clever twist designed to prevent people from losing coverage unexpectedly. For Medicare Part D, the law ensures that if the ACIP later revokes a recommendation for a vaccine after that October 25, 2024, cutoff date, Medicare plans still have to cover it based on the last recommendation that was in effect for that person. This prevents a scenario where a manufacturer updates a vaccine, the ACIP changes its guidance, and suddenly someone who was relying on the older version loses coverage. Similarly, Medicaid and CHIP are required to cover these specific ACIP-recommended vaccines, including the administration costs, until the end of 2029. This is particularly important for Medicaid, which often has more variability in coverage across states; this bill sets a clear, required floor for vaccine access.

What the Sunset Clause Means for You

While the bill is a win for vaccine access and affordability, it’s important to note the temporary nature of these protections. The requirement for zero-cost coverage under private plans and the specific mandates for Medicare, Medicaid, and CHIP all expire around the start of 2030. This means that while you are guaranteed free access to these specific shots for the next few years, Congress will have to act again before 2030 to prevent these cost-sharing requirements from potentially returning. The clock is ticking on this guarantee. For insurance companies and Medicare Part D sponsors, this bill mandates increased benefits without a clear mechanism for premium adjustment, which means they are absorbing the cost of these preventative services for the next five years.