It’s been a tumultuous time in the world of vaccinations. The Secretary of Health and Human Services replaced the entire Advisory Committee on Immunization Practices (ACIP). The Food and Drug Administration (FDA) added restrictions to vaccine approvals. A newly confirmed Director of the Centers for Disease Control and Prevention (CDC) was fired.
Under the Affordable Care Act (ACA) preventive services requirement, employer health plans and insurers must cover, without cost sharing, all immunizations recommended by ACIP and adopted by the CDC. The coverage requirement extends to both universally recommended vaccines and vaccines where shared decision making is recommended.
Here’s a summary of what you need to know about vaccinations now.
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Clinical importance: The flu vaccine reduces hospitalization due to influenza by about 60% in most years.
Current recommendations: ACIP and major professional societies recommend an annual influenza vaccine for all those ages six months or older. This is unchanged from last year.
Health plan coverage: The ACA requires that flu shots be offered without cost sharing. Employers generally cover vaccinations in both the medical and pharmacy benefits to increase member access.
Additional information: Multi-dose flu vaccines that had the preservative thimerosal are no longer approved or available. These were generally only used in large public health campaigns and represented under 6% of total flu shots in 2024. About 45% of adults and 55% of children received influenza vaccines last year.
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Clinical importance: The RSV vaccination given to pregnant women was associated with a 61% decrease in RSV infections and a 78% decrease in RSV hospitalizations among their newborns. The RSV vaccine provides 75% protection against hospitalization in adults over 60 at high risk.
Current recommendations: The ACIP and professional medical societies recommend the RSV vaccine for those over 75, for those over 50 with an underlying illness that puts them at higher risk of complications, and pregnant women between 32 and 36 weeks of gestation (from September to July) to protect their newborns. ACIP added the recommendation to vaccinate adults ages 50–59 years with an underlying illness earlier this year.
Health plan coverage: You’re required by the ACA to cover RSV vaccination without cost sharing for eligible pregnant women and those over age 55, and those over age 50 with risk factors consistent with the ACIP guidelines.
Additional information: Before vaccines, RSV caused 58,000–80,000 hospitalizations annually for those under age two and 6,000–10,000 deaths among older Americans annually. About one-third of eligible pregnant women and one-third of those over 60 at high risk had been vaccinated last year.
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Clinical importance: COVID-19 vaccinations reduced hospitalizations by 45–46% in vaccinated adults last year. A recent simulation study estimated that COVID-19 vaccinations in pregnancy could prevent 2500 hospitalizations of newborns and 450 hospitalizations of pregnant women. Previous studies have shown that COVID-19 vaccination was associated with a decreased risk of hospital admission and preterm labor. COVID-19 vaccinations are associated with a slightly increased risk of heart inflammation, especially in young men. COVID-19 infection is associated with a higher risk of heart inflammation.
Current recommendations: The FDA recently restricted the labeling for the vaccine to those who are over 65 or are six months and older and at high risk of complications. This limits the number of people who can get the vaccine. The previous recommendation was to vaccinate anyone six months of age or older, regardless of risk. The published list of risk factors includes pregnancy, sedentary lifestyle, depression, hypertension and diabetes, so a large portion of the population is eligible.
ACIP has recommended that COVID-19 vaccinations be given after shared decision making with a clinician, regardless of age or illness.
Professional societies including the American College of Obstetrics and Gynecology, the Society for Maternal and Fetal Medicine and the American Society for Reproductive Medicine recommend COVID-19 vaccines for women in pregnancy.
Health plan coverage: Employer health plans are required to cover COVID-19 vaccinations without cost sharing.
Additional Information: The only COVID-19 vaccine now labeled for use in those between six months and five years of age is the Spikevax (Moderna) vaccine, so there could be shortages of pediatric doses. Spikevax is approved for those over 6 months of age; Comirnaty (Pfizer) is labeled for use in those ages 5 and over, and Nuvaxovid (Novavax) is approved for those ages 12 and over. Moderna’s second COVID vaccine, mNEXSPIKE, is approved for those ages 65 and older.
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Clinical importance: Hepatitis B is a major cause of chronic liver disease and can be transmitted from mother to child during childbirth. Of those infected at birth, 90% will have chronic liver disease and one-quarter will die of hepatitis B related liver disease. Hepatitis B vaccination has been associated with a 99% decrease in hepatitis B cases in children and adolescents.
Current recommendations: The Hepatitis B initial vaccine is recommended by ACIP and by professional medical societies for newborns before hospital discharge, and subsequent doses are given between 1–2 months and before 18 months. Three doses of the vaccine are recommended at any age for those who weren't previously immunized. This recommendation is unchanged.
Health plan coverage: You’re required to cover the cost of the hepatitis B vaccine with no cost sharing under the ACA. This is unchanged.
Additional information: The ACIP debated, but didn't approve, a plan to eliminate the recommendation that hepatitis B vaccines be administered to newborns before hospital discharge in the September meeting.
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Clinical importance: Measles, mumps, rubella and chickenpox (varicella) were once common diseases; vaccination has led to the elimination of measles, mumps and rubella from North America, and dramatically decreased the incidence of chickenpox. Measles commonly leads to hospitalization and sometimes leads to death. Rubella is associated with severe congenital defects in children of women infected in early pregnancy.
Current recommendations: The MMR vaccine should be given separately from the varicella vaccine at 12 months. The combined MMRV (V=varicella) vaccination can be given at age four. Previously, families had the choice to give these vaccines together (an MMRV vaccine) or separately (MMR vaccine, plus a separate varicella vaccine). MMR vaccination (without varicella) is recommended at any age for those who didn't previously have two doses or those whose blood tests show no immunity to measles.
Health plan coverage: You’re required to cover the cost of MMR and varicella vaccines separately at age 12 months under the ACA. You must provide coverage for the MMRV vaccine for children age four and older.
Additional information: This combined vaccine allowed young children to get one less shot but was associated with a small increase in febrile seizures. These rare events are understandably scary for parents but not associated with long-term harm. There's no increase in adverse effects when the combined MMRV vaccine is administered to those who are four years old. Previously, 15% of children received a combined MMRV vaccine for their first dose at 12 months.
There has also been discussion of whether the MMR vaccine should be given as three separate shots at different times. There's strong evidence that the MMR vaccine that's currently available is safe and effective. There are no currently approved separate vaccinations available in the U.S. Combining the measles, mumps and rubella vaccines in a single shot leads to higher rates of adherence to the vaccine schedule.
Childhood vaccinations remain one of the most effective ways to decrease illness, save lives and save money. Childhood vaccinations, on average, save $3.30 in direct medical expenses for every $1.00 spent. As an employer, you also benefit from less time away from work due to vaccine-preventable illnesses of employees and their dependents.
The influenza vaccine is recommended for everyone six months and older.
As of fall 2025, the FDA has approved updated COVID-19 vaccines for adults aged 65 and older and individuals with underlying medical conditions. However, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that all those seeking COVID-19 vaccinations engage in shared decision making with their clinician. Therefore, anyone over six months is eligible for the COVID-19 vaccine.
The RSV vaccine is recommended for pregnant women in their last trimester during the fall, adults over 75 and those between 50–74 who are at higher risk.
Under the Affordable Care Act (ACA) preventive services requirement, employer health plans and insurers must cover, without cost sharing, all immunizations recommended by ACIP and adopted by the CDC. The coverage requirement extends to both universally recommended vaccines and vaccines where shared decision making is recommended. Therefore, as of now, employer-sponsored health plans are required to cover influenza, COVID-19) and RSV vaccines for eligible populations.
Employers can:
Fall vaccinations can prevent respiratory illness, save medical expenses and decrease employee time away from work.
Yes, some states have expanded vaccine coverage requirements for state-regulated health plans. For example, California requires that health plans cover a wide range of preventive care services, including immunizations, without cost-sharing or utilization management.
Employers should monitor updates from the CDC, FDA and ACIP, as well as state-specific regulations.
