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  5. Respiratory Immunization Coverage

Respiratory Immunization Coverage

The Centers for Disease Control has recently updated its guidelines for respiratory immunizations, including influenza, COVID-19, and RSV. The CDC recommends:

  • COVID-19 vaccination for individuals 6 months and older after a discussion with a healthcare provider.
  • Season flu vaccines for everyone 6 months and older.
  • RSV vaccination for all adults 75 or older and adults 50-74 who are at increased risk for severe RSV illness.
  • RSV immunization to protect infants & toddlers as follows:
    • Pregnant woman can receive an RSV vaccination between 32 and 36 weeks of gestation OR
    • Infants under 8 months can receive an RSV preventive antibody.
    • Some children 8-19 months at increased risk can also receive an RSV preventive antibody.

Pneumococcal vaccination is recommended for children under 5, adults 50 and older and individuals at increased risk for pneumococcal disease. Most types of health insurance cover flu, COVID-19, pneumococcal and RSV immunizations for their members without cost-sharing. Check out the coverage rules for your plan below:

Most private health plans (including Marketplace plans) cover all immunizations recommended by the CDC without cost-sharing, including flu, COVID-19, pneumococcal and RSV, as long as you go to a provider in your health plan’s network.

Exceptions: Certain health plans that existed before the ACA known as “grandfathered” plans as well as short-term plans do not have to cover immunizations.

Medicaid and CHIP programs cover all CDC-recommended vaccines without cost-sharing.

Seasonal flu, COVID-19 and pneumococcal vaccines are covered without cost-sharing by Medicare Part B. The RSV vaccine indicated for adults 60 and older is covered without cost-sharing by Medicare Part D. If patients are charged a vaccine administration fee for the RSV vaccine, they can get reimbursed by Medicare.

Tricare – which provides health coverage to people who serve in the military and their families—and the Veterans Administration (VA) cover CDC-recommended immunizations without cost-sharing.

Adults without health insurance should look for community health clinics and health departments in their area for help accessing other vaccines. Children without health coverage can receive COVID-19, RSV, pneumococcal and flu shots through the Vaccines for Children Program. Visit vaccines.gov to find provider locations in your zip code.

young girl displays her bandage from a vaccine on her arm

Page last updated: October 9, 2025

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