Does Medicaid Cover the HPV Vaccine?

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  • Does Medicaid cover the HPV vaccine? Find out who's eligible for the HPV vaccine through Medicaid and which other federal and state programs cover vaccination.

The human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in America, and there are many strains. HPV can cause various cancers and spreads from person to person through sexual contact. Having the HPV vaccine can reduce your chances of catching HPV and developing an associated disease. 

Does Medicaid cover the HPV vaccine? Below, you can find out which state and federal programs fund HPV vaccines and who's eligible. 

Does Medicaid Cover the HPV Vaccine?

Children aged 18 or younger who are eligible for Medicaid are also eligible for the Vaccines for Children Program. This program entitles eligible children to receive any vaccine recommended by the Advisory Committee on Immunization Practices (ACIP) for their age group, including the HPV vaccine. 

Medicaid enrollees younger than 21 are also entitled to the Early and Periodic Screening Diagnosis and Treatment (EPSDT) benefit. This benefit ensures that children eligible for Medicaid receive comprehensive health care services that may not be available to adult beneficiaries. Therefore, Medicaid enrollees aged 19 or 20 who are not covered by the Vaccines for Children Program can receive a free HPV vaccine through the EPSDT benefit. Neither the Vaccines for Children Program nor the EPSDT benefit permit cost-sharing, so families do not have to pay anything to have their child vaccinated. 

Adult Medicaid enrollees are entitled to a free HPV vaccine if they live in a state with expanded Medicaid. States without expanded Medicaid can choose whether to cover the HPV vaccine through their Medicaid programs.

A 2016 survey by the KFF found that at least 40 states cover the HPV vaccine, and North Carolina was the only state that confirmed it doesn't provide HPV vaccine coverage. You can check the rules in your state by contacting your state Medicaid Agency

What If I Don't Qualify for Medicaid?

If you don't qualify for Medicaid but can't afford to pay for the HPV vaccine out of pocket, you may be eligible for an HPV vaccine through the Section 317 Immunization Program. This program allows states to purchase and distribute vaccines and pays for local, state and national vaccination schemes to vaccinate low-income and uninsured citizens. Eligibility requirements vary widely depending on local priorities, and many schemes prioritize certain groups. 

If your child is uninsured and doesn't qualify for Medicaid, they may be eligible to enroll in the Children's Health Insurance Program (CHIP). Income-based eligibility criteria vary across states, but every CHIP program must pay for ACIP-recommended vaccines for its beneficiaries. 

Are HPV Vaccines Free?

HPV vaccines are free for children under 21 enrolled in Medicaid. Vaccines are also free for adults in states with expanded Medicaid or that voluntarily cover the HPV vaccine.

You may also be entitled to a free HPV vaccine if you have private health care insurance. The Affordable Care Act (ACA) requires most private insurers to cover the HPV vaccine in their policies, provided the beneficiary is vaccinated at an in-network clinic. You may be required to pay copayments, coinsurance or deductibles.

If you're uninsured and don't qualify for state or federal health care programs, you'll need to pay for your HPV vaccine out of pocket. You should expect to pay around $250 for each dose. 

Can I Get the HPV Vaccine If I Am Over 26?

ACIP recommends that all children receive the HPV vaccine routinely when they're 11 or 12, but it can be administered from age 9. It also recommends that all adults receive the HPV vaccine up to the age of 26 if they weren't vaccinated as children. 

However, you can still have the vaccine between the ages of 26 and 45 if your doctor agrees it could benefit you and you haven't already been vaccinated. Vaccination in this age bracket is generally less effective because you're more likely to have already contracted HPV, and the vaccine is more effective if you receive it during childhood.

What Is the HPV Vaccine?

The HPV vaccine reduces the risk of contracting cancers caused by HPV. There are three FDA-approved HPV vaccines, but Gardasil 9 is the only vaccine currently available in the United States.

The HPV vaccine can prevent cervical, vaginal and vulval cancers in girls and women if they are vaccinated before exposure to the virus. Furthermore, it can also help prevent various cancers affecting women and men, such as anal and throat cancers, and has a protective effect against genital warts. It's thought that vaccinating boys could help reduce the rate of gynecologic cancers in their future female partners by reducing viral transmission. 

How Is the HPV Vaccine Administered?

HPV vaccines are administered into the upper arm or thigh. People who are vaccinated between the ages of 9 and 14 should receive two HPV vaccine doses at least 5 months apart unless they are immunocompromised. 

Immunocompromised people and those between the ages of 15 and 26 should receive three doses. The first two doses should be given at least 4 weeks apart, and the third dose should be given at least 12 weeks after the second. There should be an interval of no less than 5 months between the first and last doses. 

Adults between the age of 26 and 45 should also be vaccinated following the three-dose regimen if they decide they want it following consultation with their doctor. The HPV vaccine can be administered with other vaccines during the same appointment.

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