The Pennsylvania Insurance Department (PID) issued a notice that reaffirms PID’s expectations for insurers to cover the COVID-19 vaccine and other important vaccines during the 2025–26 calendar years. These vaccines should be covered at no cost to consumers, with no extra fees or unnecessary hurdles, and consistent with approved policy language, through at least Dec. 31, 2026. This notice reinforces Gov. Josh Shapiro’s Executive Order that safeguards Pennsylvanians’ access to vaccines and protects their freedom to make their own healthcare decisions.
What This Means for Pennsylvanians:
- No Cost: COVID-19 vaccines and other recommended vaccines should be covered without copays, deductibles, or other costs, when administered by an in-network provider.
- No Barriers: Insurers should not put up extra steps that make it harder for people to get vaccinated.
- Based on Medical Guidance: Vaccines are to be covered if they follow the recommendations of national medical groups like the CDC, FDA, ACOG, AAP, and AAFP. The State Board of Pharmacy recently approved several trusted medical organizations, including the FDA and major physician groups, to set vaccine guidelines in Pennsylvania. This means pharmacists and other providers can follow these updated guidelines when giving vaccines.
- Encouraged Coordination: This guidance applies to most health insurance plans sold in Pennsylvania, including major medical plans and some limited-coverage plans. However, PID also encourages insurers who handle self-funded employer health plans (plans not directly regulated by the state) to make sure vaccine access stays consistent for their members.
PID urges insurers to share clear and accessible information with Pennsylvanians online and through their customer service efforts, so Pennsylvanians know exactly how to get vaccinated. Contact Katie Noss, PACHC Director of Clinical Operations with questions.