Be warned: Check your insurance before getting a COVID-19 vaccine this year

Ed Pliml was shocked to learn that the new COVID-19 booster shot was going to cost him more than $100 thanks to a change in federal funding.

He showed CBS News Chicago the mark he received from the recently released updated booster shot, but he said it was a hassle to get.

“I thought it would be just as easy as every other year,” he said.

For Pliml, it meant dropping by the local pharmacy where immunizations were free in the past.

But this time, the pharmacy said they could give him the flu shot, “but that the COVID vaccine wasn’t covered, which I just assumed was a mistake,” Piml said. “And so, he rechecked, and he said, ‘Nope, the flu vaccine is covered. The COVID vaccine isn’t.'”

The out-of-pocket cost was more than $100. Other patients might run into the same issue if they’re not prepared.

The Centers for Disease Control and Prevention explained that the Federal Drug Administration ended a program that provided free COVID-19 vaccines in August of 2024.

“The COVID-19 vaccine is no cost with most insurances,” said Sume Chakkalakel, a CVS pharmacist.

Chakkalakel said the one extra step patients will now need to take to get a COVID-19 vaccine for free.

“You just have to make sure that you go to an in-network pharmacy to get that vaccination,” Chakkalakel said.

In other words, those wanting the jab will have to check their health insurance plan. If their insurance doesn’t cover a COVID-19 vaccine at CVS, pharmacists will still provide one, but the charge will be around $200.

The Walgreens out-of-network price for the new COVID-19 booster was a little harder for CBS News Chicago to find. Patients will have to search by the vaccine’s official name. Pfizer’s vaccine is called Cominarty. Moderna’s vaccine is called Spikevax. Novavax also has a COVID-19 vaccine on the market.

Piml said it took him an hour and a half to a couple of hours of trying to figure out who would cover a vaccine for him. He was frustrated by what he said was conflicting information from his Medicaid provider, Blue Cross Community.

“I still have no idea what is going on,” he said.

In a statement, BlueCross, Blue Shield of Illinois said, “Coverage and networks may vary by plan. If you have questions about your access to COVID-19 or flu vaccine coverage, please visit www.bcbsil.com/covid-19/whats -covered/covid-19-vaccines-and-boosters.html or call the number on your member ID card.”

In the meantime, Piml found a spot to get his shot where insurance coverage didn’t matter. But even that was a challenge because not all medical providers offer the boosters just yet.

For example, it likely won’t be until October that the Chicago Department of Public Health will be able to offer COVID vaccines for adults at its free immunization clinics. The CDPH said for individuals with private insurance or who are covered by Medicare or Medicaid, that should cover the cost of the vaccination

Chakkalakel, the pharmacist, said she hopes the information will get to patients in the next few weeks for those looking for vaccines.

Before leaving the CVS, CBS News Chicago asked a couple of rapid-fire questions about what patients should know ahead of the fall and winter.

Who should get the new COVID-19 shot?

“Right now, there is a universal recommendation that all patients 6 months and up get vaccinated,” Chakkalakel said.

Why should we get boosted again?

“The immunity to the virus does wane over time,” she said.

And finally, can patients get the flu and COVID-19 vaccines at the same time?

“We’ve had multiple patients getting them at the same time, getting them in the same arm,” she said.

The side effects of the vaccines are usually mild.

For those who are uninsured or under-insured, CDPH will have vaccinated at its three CDPH Immunization Clinics. Walk-ins are welcome, but registration is highly encouraged. Create an account and register for an appointment at https://getvaxchi.chicago.gov or by calling the clinic. Call ahead to make sure COVID-19 vaccine doses have arrived.

The Illinois Department of Public Health says those who don’t have healthcare coverage can get a vaccine for children 18 and under through its Vaccine for Children Program.

Adults without insurance have options, including checking their local health department or using the search capability to contact with a free and charitable clinic or a community health center.

For more information on vaccines at CVS, click here, and for information on vaccines at Walgreens, click here.