There has been confusion about the COVID-19 vaccination guidelines and other vaccine updates for Americans this fall. To gain clarity about this year’s recommendations, insurance coverage, and eligibility, Dr. Jason L. Schwartz, an associate professor at the Yale School of Public Health and an expert on U.S. vaccine policy, spoke with Dr. Jason L. Schwartz, an associate professor at the Yale School of Public Health and an expert on U.S. vaccine policy.
New COVID-19 Vaccine Guidelines
This year’s COVID-19 vaccine recommendations have created a complex situation. The Advisory Committee on Immunization Practices (ACIP), which advises the Centers for Disease Control and Prevention (CDC), and the U.S. Food and Drug Administration (FDA) have divergent views.
At a meeting on Sept. 19, the ACIP recommended that anyone 6 months of age and older should have the option to get the new COVID-19 vaccine after consulting with a healthcare provider. This is called a “shared clinical decision-making process.” In contrast, the FDA has officially approved the vaccine only for people 65 years of age and older and those at high risk of severe illness.
While not unprecedented, ACIP’s decision to allow the use of a vaccine beyond FDA approval, known as “off-label use,” is highly unusual. Typically, off-label use is reserved for limited circumstances and small populations. Here, however, ACIP has paved the way for the off-label use of a vaccine for millions of healthy Americans ages 6 months to 65 years. The recommendation emphasizes the “can be vaccinated” option rather than the “should be vaccinated” recommendation. This means that the vaccine is not actively encouraged to be given, but is available as an option for those who want to get it..
Insurance Coverage and Cost
While the ACIP recommendation is a “shared clinical decision-making process,” it is considered an official recommendation. Therefore, if the CDC Director accepts it, it will be included in the official immunization schedule. This is expected to result in insurance coverage.
Children: Free coverage of COVID-19 vaccines will continue for all children, regardless of insurance status.
Adults: The cost of the vaccine will be covered for adults with private insurance, Medicare, or Medicaid.
Uninsured Adults: Vaccine coverage for uninsured adults is a major gap in the health care system, and cost can be an issue for them.
The ACIP recommendation is currently only a recommendation and will only become official guidelines once it is accepted by the CDC Director.
New Covid vaccine guidelines and vaccine availability
Where and by whom the vaccine can be given depends on state laws. Many states have allowed pharmacists to provide counseling and vaccinations without a prescription. Therefore, in most states, those who want to get the vaccine can likely get it at their local pharmacy at no cost. However, confusion in the guidelines is leading some pregnant women, people under 65, and others to be mistakenly told that they need a doctor’s appointment. It is important to contact your healthcare provider, pharmacy, or local health department for accurate information.
Who needs to get vaccinated?
If you have been vaccinated before, whether you need to get vaccinated this year depends on your health. The ACIP has not recommended any specific priority groups other than those over 65. However, other medical and public health organizations have said that vaccination is especially important for certain groups. For example, Connecticut’s recommendations say the following groups “should” get vaccinated:
Previously unvaccinated children
Adults 65 years of age and older
Pregnant women
People of any age who are immunocompromised or have risk factors for severe COVID disease
Other healthy and previously vaccinated children and adults under 65 are suggested to “be vaccinated if desired.” It is best to consult your doctor to make the right decision for you.
Changes to other vaccines
MMRV vaccine
The MMRV vaccine, which combines measles-mumps-rubella (MMR) and varicella (chickenpox), is available. Previously, the first dose of this vaccine was recommended separately (MMR and varicella) for children under 4 years of age, because the combined vaccine was associated with a small increase in febrile seizures. Now, ACIP has eliminated the option of the combined MMRV vaccine for this age group and recommends only the separate vaccines. However, there has been no impact on the safety or effectiveness of the MMR and varicella vaccines. MMR vaccination is very important due to the increase in measles cases in the United States this year.
Hepatitis B Vaccine
Currently, there have been no changes to the recommendations for the hepatitis B (HepB) vaccine. The recommendation to give the first dose to newborns in the hospital immediately after birth remains. This policy has led to a significant decrease in hepatitis B infection and related liver diseases in newborns in the United States over the past few decades. ACIP had considered postponing the first dose until the 1-month-old baby checkup, but no decision has been made and this may be reconsidered at a future meeting.
What are the new covid vaccine guidelines ?
The new COVID-19 vaccine guidelines for fall 2025 are split. The FDA has approved the new vaccine only for individuals aged 65 and older or those at high risk. However, the CDC’s advisory committee (ACIP) recommends it as an optional choice for everyone 6 months and older, following a discussion with a healthcare provider.
Vaccination is most strongly recommended for priority groups, including seniors, pregnant women, and the immunocompromised. For other healthy individuals, the shot is considered optional. The vaccine is expected to be covered by most insurance plans and available at local pharmacies.
What are the guidelines for the new covid vaccine?
The new COVID-19 vaccine guidelines for fall 2025 are split between two main U.S. health agencies. The FDA has strictly approved the new vaccine, which targets the JN.1 variant, only for individuals aged 65 and older and those at high risk for severe disease
What are the vaccine recommendations for children?
The American Academy of Pediatrics (AAP) recommends the new vaccine for children and adolescents based on age and risk. This includes a vaccination series for infants, single doses for high-risk children, and offering a dose to any child whose parent desires protection. Parents should discuss the benefits with a healthcare provider
Will my insurance cover the cost of the new vaccine?
For most people, yes. The cost is expected to be covered for adults with private insurance, Medicare, or Medicaid, and it will remain free for all children regardless of insurance status. However, coverage for uninsured adults is a known gap in the system