Will health insurance still cover vaccines if Florida makes them optional?

Florida has begun the process to make at least some of the mandatory vaccines that kids currently need for school optional.

The decision has raised concerns among many in the medical community who worry it could lead to fewer kids getting vaccinated, and in turn, more outbreaks of contagious diseases. Some are also wondering how easy it will be for parents to vaccinate their child.

And it’s raised another major question: If school vaccines become optional, will insurance companies still cover the shots?

Most health insurers would likely still cover vaccines, even if the shots become optional in Florida, as long as federal policies don’t change. That includes private health insurance, Medicaid and plans obtained through the Health Insurance Marketplace created through the Affordable Care Act, also known as Obamacare.

That’s because “federal law mandates that insurance plans cover routine immunizations,” the U.S. Centers for Disease Control and Prevention told the Miami Herald in an email. The CDC sets the immunization schedule for routine immunizations based on the recommendations of its advisory committee — the CDC Advisory Committee on Immunization Practices.

Health insurer Aetna, which is owned by CVS, currently covers all vaccines that are required for kids to attend school in Florida. The health insurer told the Herald it does not expect its coverage to be impacted if the shots become optional.

Aetna said that’s because its vaccine coverage is based on the recommendations made by the CDC’s advisory committee, as well as any applicable laws.

Most health insurance plans cover the recommended annual flu vaccines, for example, though some may require people to get vaccinated at in-network providers.

All health insurance plans that are obtained through the ACA Health Insurance Marketplace, along with most private insurance plans, are also required to cover certain vaccines recommended by the CDC’s advisory committee without charging a copayment or coinsurance when administered at an in-network provider, according to the CDC’s website.

Vaccines that are generally covered include the vaccines Florida has long mandated kids get for school.

Besides the CDC and its advisory committee, health insurers also generally consider clinical recommendations made by other medical organizations, including the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the U.S. Preventive Services Task Force, when making coverage decisions for vaccines and other preventive care.

Florida’s push to make all vaccines optional comes at a time when the CDC and its advisory committee are in turmoil. And all eyes are on D.C., where a vaccine health policy spar is underway.

Former CDC Director Dr. Susan Monarez is preparing to testify to Congress next week following her abrupt firing last month. Monarez, who was nominated by President Donald Trump to lead the federal health agency, was fired less than a month into the job after clashing with U.S. Health and Human Services Secretary Robert F. Kennedy Jr. over his vaccine policy agenda. Other top CDC officials have resigned.

Kennedy has also recently cleaned house in the CDC’s critical advisory committee, which makes vaccine policy recommendations to the CDC’s director, including those outlining who should get vaccinated, with what vaccines and at what age. The health secretary in June removed all 17 members of the CDC’s advisory committee and is in the process of adding new members to the group ahead of its September meeting.

Kennedy said in a news release that the removal and replacement of the committee members will rebuild public trust. Critics say it’s doing the exact opposite. The nation’s top medical organizations, including the American Medical Association and the American Academy of Pediatrics, were also given the boot and will no longer be part of the committee’s vaccine recommendation review process.

AHIP, a national trade association that represents the health insurance industry, told the Herald in a statement that it’s “monitoring the forthcoming meetings and recommendations” the CDC and its advisory committee will make.

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Vaccines can sometimes be pricey for people without insurance or who are underinsured.

However, the CDC told the Herald in an email that it doesn’t expect Florida’s push to make vaccines optional will impact its federal Vaccines for Children program, which provides free vaccines to eligible children. The program provides vaccines approved by the CDC and recommended by its advisory committee.

The Florida Department of Health’s website states kids 18 and younger who are eligible for free vaccines through the program include:

The program “is not connected to or dependent on state level school immunization requirements and has never factored in state requirements as part of participation,” the CDC said in an email to the Herald, noting that it “sends vaccines to all states and select cities regardless of state law.”

The federal health agency said providers are “directed to comply with the child and adolescent schedule as recommended by the Advisory Committee on Immunization Practices (ACIP) unless the recommendation contradicts state law, including any law pertaining to religious and other exemptions.”

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The Florida Department of Health is already in the process of making four mandatory school vaccines optional: those for varicella (chickenpox); hepatitis B; haemophilus influenzae type b, or Hib; and pneumococcal disease.

Florida’s state legislature needs to get involved to make other mandatory school vaccines optional, including those that protect against diphtheria, tetanus, pertussis (whooping cough), polio, measles, mumps and rubella.

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