The Centers for Disease Control and Prevention (CDC) recently revised the U.S. childhood immunization schedule, as announced by the Department of Health and Human Services (HHS). The childhood immunization schedule provides guidance to healthcare providers on what vaccines children should receive and when.
The updated schedule will retain the three categories of recommendations used to organize childhood immunizations, all of which must be covered with no copays or out-of-pocket costs:
- Immunizations Recommended for All Children
- Immunizations Recommended for Certain High-Risk Groups or Populations
- Immunizations Based on Shared Clinical Decision-Making (i.e., individual-based decision-making for parents, in consultation with a healthcare provider)
However, certain vaccines are no longer recommended for all children and instead now fall within one or both of the remaining two categories. The updated schedule also reduces the recommended doses for certain vaccines.
Under the Affordable Care Act, non-grandfathered group health plans must provide certain preventive care benefits without cost sharing, including immunizations for routine use in children, adolescents and adults recommended by the Advisory Committee on Immunization Practices. A recommendation is considered to be for routine use if it is listed on the CDC’s immunization schedules.
The updated schedule does not change what childhood immunizations must be covered by a non-grandfathered group health plan on a first-dollar basis. According to the related HHS Fact Sheet, all immunizations recommended by the CDC as of December 31, 2025, must continue to be covered without cost sharing.
Going forward
The updated childhood immunization schedule is now in effect. Employer plan sponsors of non-grandfathered group health plans must cover all required childhood immunizations without cost sharing and should confirm their plan is compliant.