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COVID-19

COVID-19 Vaccine Access and Insurance Coverage: Uncertainty Surrounds Fall Shots

Strategic Insights

— 2 min read

The federal government's new limits on who is eligible for COVID vaccines have caused confusion over accessibility, particularly for individuals not in high-risk groups and those on Medicaid. Health and Human Services Secretary Robert F. Kennedy Jr. announced a series of moves this week that will limit who is eligible for COVID vaccines as the stratus variant spreads across the country. The FDA rescinded general emergency use authorizations for Pfizer and Moderna mRNA shots, according to Kennedy. Boosters for high-risk patients were approved, though.

Key Takeaways:

  • The FDA rescinded general emergency use authorizations for Pfizer and Moderna mRNA shots, but approved boosters for high-risk patients.
  • Patients who want COVID vaccines will first have to consult with their doctor rather than booking directly with a pharmacy.
  • Adults 65 and older are eligible for an updated Pfizer-BioNTech COVID vaccine, as well as new shots from Moderna and Novavax.
  • Anyone between 5 and 64 is eligible if they have at least one underlying health condition, including asthma, cancer, kidney disease, heart conditions, HIV, certain mental health conditions, physical inactivity, and smoking.
  • The new FDA policy doesn't approve the Pfizer vaccine for healthy children under age 5, leaving it open to a doctor's discretion to prescribe off-label shots.
  • The Moderna vaccine has approval from the FDA for children 6 months old and up with underlying conditions.
  • Many health experts argue that shots are still important for the general public, which remains at risk for severe outcomes as well as long COVID.
  • Individuals who aren't part of the recommended groups may not be covered by insurance and forced to pay out of pocket, which can be a strain, especially for families on Medicaid.
  • Medicaid covers over 285,000 DC residents, including 95,000 infants and children, according to D.C. city officials.

Statistics:

  • COVID vaccine prices: $140 per shot (Source: CDC)
  • Medicaid coverage: 285,000 DC residents, including 95,000 infants and children (Source: D.C. city officials)
  • FDA approvals:

+ Pfizer-BioNTech COVID vaccine for adults 65 and older

+ Moderna vaccine for children 6 months old and up with underlying conditions

+ Novavax shots for adults 12 and older

  • CDC cases:

+ Low COVID rates in D.C., Virginia, and Maryland

+ Cases and related ER visits increasing in the two states and across the country

  • Mortality rates: Lower than the surges seen during the height of the pandemic (Source: CDC)

Sources:

  • Axios, "COVID vaccine 2025: FDA recommendation, RFK" (August 27, 2025)
  • Axios, "CDC COVID vaccine rules, recommendations, high-risk FDA" (August 28, 2025)
  • Axios, "RFK anti-vaccine revolution" (August 15, 2025)
  • Axios, "COVID-19 vaccine policy, cases rise" (August 27, 2025)
  • Axios, "CDC's Vaccines for Children Program" (various)
  • WAMU, "Fearing coverage loss, some parents rush to vaccinate their kids" (August 27, 2025)
  • New York Times, "CVS pharmacy COVID vaccine 16 states" (August 28, 2025)
  • Help Senate, "Cassidy calls for vaccine committee meeting to be postponed following CDC departures" (various)
  • CVS, statements to Axios
  • CDC, data on respiratory viruses (various)
  • CBS News, "COVID-19 cases rise in summer 2025, CDC data shows" (various)

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