Insurance Coverage for Vaccines in Private Health Plans

Learning Objectives for this Presentation: Participants will have a greater understanding of vaccine coverage for enrollees in fully insured health plans.

Background: Underinsurance for vaccines can cause financial barriers to vaccination, but has not been well quantified.

Objectives: To assess benefits coverage for child, adolescent, and adult vaccines in a nationwide sample of fully insured private health plans

Methods: The three private health insurance carriers with highest member enrollment in 47 states were surveyed to determine policies regarding vaccine coverage. Carriers were identified as multi-state, Blue Cross or local independent carriers. Plan types included HMO, PPO, POS and ‘Other’ (indemnity and high-deductible); self-insured plans were excluded from the analysis. Univariate and bivariate analyses were conducted; Fisher's exact test was used for significance testing.

Results: Insurance carrier response rate was 71%. Full coverage (no vaccine copay or  coinsurance) for specific vaccines was: Tdap-74%, PCV-72%, Rota-72%, HPV-71%, HepA- 68%, MCV-67%, influenza (inactivated)-67%, LAIV-63% and zoster-57%. Compared with plans offered by Blue Cross carriers (28%), higher proportions of multi-state carriers (46%) and local independent carriers (64%) had plans with full benefits coverage for vaccines (i.e., no dollar limit on preventive care, no annual deductible or if annual deductible, immunizations not subject to the deductible, and all immunizations fully covered) (p=0.01). Compared with PPO (35%) and other (13%) plans, higher proportions of HMO (71%) and POS (56%) plans had full benefits coverage for vaccines (p= 0.02).

Conclusions: Underinsurance likely contributes to underimmunization among children, adolescents, and adults. Current levels of benefits coverage leave room for improvement in large private health plans, especially within Blue Cross plans and indemnity or high-deductible plans.