Are you planning to get a COVID-19 vaccine? That’s a question that’s gotten a lot more complicated for many people.
Your decision might hinge on factors like your age, insurance, overall health, and even whether you can find a healthcare provider willing to give you the shot.
This year, what used to be a straightforward seasonal vaccine process has turned into something quite messy, mainly due to new federal guidelines about who can receive the vaccines. This raises additional questions about whether pharmacists will be able to administer them and whether insurance will cover the costs.
The U.S. Food and Drug Administration has approved new vaccines from Pfizer, Moderna, and Novavax, but there are some new conditions attached. It’s still unclear how this will all unfold in practice.
What’s different now?
The new shots are now approved for those aged 65 and older, as well as for younger individuals with certain health conditions that put them at greater risk for severe COVID-19.
This includes people with asthma, cancer, heart or lung issues, obesity, depression, a smoking history, or those who are physically inactive.
“A significant number of people would qualify for these vaccines, even if they’re under 65,” noted Dr. Paul Sax, clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital in Boston.
Until recently, the U.S. — guided by independent experts advising the Centers for Disease Control and Prevention — has suggested annual COVID-19 vaccinations for everyone aged six months and up.
But Health Secretary Robert F. Kennedy Jr. dismissed all members of that Advisory Committee on Immunization Practices this year. His replacements haven’t yet offered new recommendations.
Where can I find a shot?
Most people in the U.S. typically get their COVID-19 vaccines at local drugstores, according to the CDC. However, the ease of access this fall may vary based on your location.
Nineteen states have laws restricting pharmacists to only administer vaccines recommended by ACIP, the American Pharmacists Association reports.
In these states, pharmacies might not be able to give out vaccines to those who fall within the FDA’s more limited eligibility until the committee provides a new recommendation.
Additionally, some pharmacists might hesitate to vaccinate individuals who don’t meet the FDA criteria, said Brigid Groves, a pharmacist and vice president with the American Pharmacists Association.
Will insurance cover COVID-19 vaccines?
For those aged 65 and older, the FDA’s recent decision indicates that Medicare will cover the vaccines.
For everyone else, the situation is still developing. It’s advisable to check with your insurance provider or employer regarding coverage.
Historically, employers and insurers have covered the full costs of the vaccines due to ACIP recommendations.
Some may continue this practice. For instance, Walmart has stated it will cover these shots for its employees, and the health system Kaiser Permanente, which serves over 12 million people, has indicated it will keep covering them as well.
Why might vaccines still be covered?
Vaccines can save money by preventing costly medical care, such as emergency room visits or hospitalizations.
Moreover, they help keep employees healthy and reduce the risk of spreading the virus in the workplace. Companies are also aware of healthcare affordability for lower-paid employees, noted Beth Umland, director of health and benefits research for Mercer.
The cost for vaccines without insurance can exceed $150.
Insurers often consider more than just the CDC committee’s recommendations when deciding on coverage; they may also take into account the views of medical groups, like the American Medical Association, which advocates for vaccinations.
Navigating conflicting advice
In May, Kennedy — a prominent figure in the anti-vaccine movement — stated that COVID-19 vaccines should no longer be recommended for healthy children and pregnant women.
However, the American College of Obstetricians and Gynecologists has countered this by stating that pregnant women should still get vaccinated. The American Academy of Pediatrics is also continuing to recommend vaccinations for children aged six months to two years, which contradicts Kennedy’s announcement.
This sort of mixed messaging has led to a lot of confusion among patients regarding which guidance to follow, remarked Groves.
“There’s just a lot of confusion out there,” she shared. “People are questioning, ‘Why should I even get it?’”
Is a vaccine still necessary?
Those inclined to get vaccinated usually look to do so in the fall as a precaution for a potential winter surge in cases.
Health experts strongly recommend vaccinations for older individuals and those with specific health concerns, according to Sax from Brigham and Women’s.
While most people have some level of immunity from previous COVID-19 infections or vaccinations, getting an annual shot still seems wise.
This existing immunity means your body can respond more effectively to infections than in the early days of the pandemic, explained Andrew Pekosz, a viral expert at Johns Hopkins University.
“That’s one reason COVID hospitalizations have decreased: population immunity is high,” he noted. “However, that immunity isn’t flawless, and it does decrease over time.”
