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BumRushDaShow

(158,835 posts)
Thu Aug 21, 2025, 10:34 AM Thursday

For some, fall Covid shots may come with copays -- or no coverage at all

Source: NBC News

Aug. 21, 2025, 5:00 AM EDT / Updated Aug. 21, 2025, 9:22 AM EDT


If you’re in good health and plan to get a Covid shot this fall, you might end up with an unwelcome surprise: a bill.

The Food and Drug Administration is expected to approve the next round of Covid shots soon, but only for a smaller, high-risk group — adults 65 and older and people with underlying health conditions. The Centers for Disease Control and Prevention is likely to follow suit, limiting its recommendation on who should get the shots to the same groups. (The CDC currently recommends Covid vaccination for everyone 6 months and older.)

The change, experts say, could affect what insurers are willing to cover for everyone else who doesn’t fall under a high-risk group. By law, most health insurance plans are required to fully cover vaccines recommended by the CDC and its outside advisory committee, the Advisory Committee on Immunization Practices (ACIP).

For those who don’t fall under the CDC’s new recommendations, experts say coverage would depend entirely on their insurance — with some deciding to fully cover the shot, others requiring a copay and some not covering it at all. Without insurance, a Covid shot can cost up to $140, according to the CDC’s vaccine price list.

Read more: https://www.nbcnews.com/health/health-news/-fall-covid-shots-may-come-copays-no-coverage-rcna226160

21 replies = new reply since forum marked as read
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For some, fall Covid shots may come with copays -- or no coverage at all (Original Post) BumRushDaShow Thursday OP
BMI greater than 30 is a risk factor... kirby Thursday #1
My BMI is 23% despite losing 60 pounds. ProudMNDemocrat Thursday #3
I have Tri-Care for Life in addition to Medicare. ProudMNDemocrat Thursday #2
I guess insurers would rather cover huge hospital stays. C Moon Thursday #4
I think insurers would actually prefer if we all die, rather than pay a claim Walleye Thursday #6
The way they fight approving medical care/tests I think you are right... "Give us money and just go die"...nt mitch96 Thursday #17
I don't think that the $140 includes the cost of administering the vaccine. Another, like $60? progree Thursday #5
Check your local Health Department. Hope22 Thursday #8
Well, it doesn't matter to me personally since I'm over 65. But I think in general, without insurance progree Thursday #9
I certainly didn't think you made it up. Hope22 Thursday #10
From what I hear, there are income guidelines on using community health services progree Thursday #12
Where did you hear this? Hope22 Friday #18
A friend urged me to check out Southside Community Health Services in Minneapolis progree Tuesday #19
Of course a big part of stopping a contagious disease markodochartaigh Thursday #7
It seems pretty clear... SickOfTheOnePct Tuesday #20
Is it too soon to blame China? twodogsbarking Thursday #11
I got the flu shot lasr week. BidenRocks Thursday #13
Why the talk about how we'll get used to this without at least calling it out for what it is -- creeping privatization! ancianita Thursday #14
RFK Jr. is going to kill people LetMyPeopleVote Thursday #15
Let's hope the insurance companies are smarter than Kennedy. It is manifestly in their self-interest Bluetus Thursday #16
I'm getting mine in September, with my flu shot. ananda Tuesday #21

ProudMNDemocrat

(20,108 posts)
3. My BMI is 23% despite losing 60 pounds.
Thu Aug 21, 2025, 10:44 AM
Thursday

Women carry at least 10% more body fat due to our hormonal and physical makeup.

ProudMNDemocrat

(20,108 posts)
2. I have Tri-Care for Life in addition to Medicare.
Thu Aug 21, 2025, 10:42 AM
Thursday

Through my late husband's Military Service that he earned for 22 total years of service in the US Air Force in the 1960's and an additional 18 years with the MN Army and Air National Guard from 1981 to the end of 1999.

While I may be one of the few fortunate ones, I realize others will not be.

mitch96

(15,433 posts)
17. The way they fight approving medical care/tests I think you are right... "Give us money and just go die"...nt
Thu Aug 21, 2025, 04:06 PM
Thursday

progree

(12,241 posts)
5. I don't think that the $140 includes the cost of administering the vaccine. Another, like $60?
Thu Aug 21, 2025, 11:05 AM
Thursday
Without insurance, a Covid shot can cost up to $140, according to the CDC’s vaccine price list.

Hope22

(4,105 posts)
8. Check your local Health Department.
Thu Aug 21, 2025, 12:11 PM
Thursday

I doubt they would have a fee for administering it.

progree

(12,241 posts)
9. Well, it doesn't matter to me personally since I'm over 65. But I think in general, without insurance
Thu Aug 21, 2025, 12:17 PM
Thursday

Walgreens etc. are going to charge for that, they aren't going to eat the cost because they are not a charity. I've also seen this in articles I've read, it's not something I made up.

Hope22

(4,105 posts)
10. I certainly didn't think you made it up.
Thu Aug 21, 2025, 12:24 PM
Thursday

My point is if these corporations charge an admin fee people should use their local health departments. That is what they are there for. People are living on tighter and tighter budgets.

progree

(12,241 posts)
12. From what I hear, there are income guidelines on using community health services
Thu Aug 21, 2025, 12:29 PM
Thursday

They do not have infinite budgets. Anyway, just another hoop for regular people to jump through, not good.

Hope22

(4,105 posts)
18. Where did you hear this?
Fri Aug 22, 2025, 08:14 AM
Friday

I would be interested to read it. I don’t find it to be the case and have used the system over my lifetime.

progree

(12,241 posts)
19. A friend urged me to check out Southside Community Health Services in Minneapolis
Tue Aug 26, 2025, 06:47 PM
Tuesday

There's a sliding fee that begins at 100% of federal poverty guidelines and ends at 200% of FPG.

southside community health services sliding fee

https://www.google.com/search?q=southside+community+health+services+sliding+fee&sca_esv=2fdb4996cfdf24b0&sxsrf=AE3TifO4q5REwZQdU6WvP2fl-xkNs0BuUw%3A1756247085381&ei=LTSuaNqAF8T-ptQPguyegAc

It would be nice if medical care was free for everyone, then we wouldn't need the ACA or Medicare or Medicaid or any of that. As the righties keep saying, one can just show up in an emergency room where they have to treat everyone. Trouble is, they do enough to stabilize you and then you're back on the street.

As for my friend (whose income was very much on the low side), she found they didn't provide some services she needed, but fortunately managed to get on Medicaid.

markodochartaigh

(3,722 posts)
7. Of course a big part of stopping a contagious disease
Thu Aug 21, 2025, 11:25 AM
Thursday

is having as many people as possible in the population immune to the disease. And there are usually two ways to be immune, having had the disease and being vaccinated.
So having fewer people vaccinated means that everyone in the population has a higher risk to get the disease.
Even people doing everything that they can to stay safe, including getting vaccinated, are at higher risk because the level of vaccinated in society is less.
Still, those who are vaccinated have lowered their own risk of serious complications.

SickOfTheOnePct

(8,386 posts)
20. It seems pretty clear...
Tue Aug 26, 2025, 06:57 PM
Tuesday

...that COVID vaccines don't stop transmission, rather they mitigate the effects, which is of course very important.

BidenRocks

(2,064 posts)
13. I got the flu shot lasr week.
Thu Aug 21, 2025, 12:32 PM
Thursday

Covid was not out yet.

Chump and brain worm will work to kill it.

They have shown that perfectly good food and medical supplies can be destroyed.

Et Tu Covid mRNA vaccine?

ancianita

(41,465 posts)
14. Why the talk about how we'll get used to this without at least calling it out for what it is -- creeping privatization!
Thu Aug 21, 2025, 01:18 PM
Thursday

What's a "high risk" group defined as... the high risk for companies of covering people who are at high risk of dying? The old, the poor, the sickly, the isolated?

From no public bathrooms to no public health, all of this is exactly how privatization works.

Bluetus

(1,420 posts)
16. Let's hope the insurance companies are smarter than Kennedy. It is manifestly in their self-interest
Thu Aug 21, 2025, 01:49 PM
Thursday

to have their customers vaccinated. It is estimated that, now that the research is largely done, COVID vaccinations a about $3 each. Figure another $27 for distribution and administration costs, and a $30 payment by the insurance companies would probably be about right.
https://peoplesmedicines.org/resources/media-releases/moderna-vaccine-price-hike-would-be-4000-mark-up-above-cost/

And if they don't cover the vaccination, then the result might be $250 for a clinic visit plus antibiotics. Or if the customer is hospitalized, now we're talking a cost to the insurance company of $2500 to $250,000, all of which could be avoided by that $30 ounce of prevention.

So let's hope the insurance companies are at least halfway smart.

ananda

(32,887 posts)
21. I'm getting mine in September, with my flu shot.
Tue Aug 26, 2025, 07:58 PM
Tuesday

I talked to the pharmacist about it the other day.

He said September is a good time to do this.

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