Immunization/Vaccination Coverage

Earlier this year, the U.S. Department of Health and Human Services (HHS) downgraded some recommendations for fall respiratory immunizations as well as other non-seasonal immunizations. These federal recommendations not only influence the vaccines that health care professionals choose to offer but also determine which vaccines your health insurance plans are required to cover and for which individuals. In response, Illinois has taken measures to make its own science-based immunization recommendations and coverage requirements to protect Illinoisans from deadly diseases.

On September 12, 2025, Governor JB Pritzker issued Executive Order 2025-04, which charged state agencies with developing state-specific guidance aimed at protecting Illinoisans’ access to life-saving immunizations: Gov. Pritzker Issues Executive Order to Protect Life-Saving Immunization Access for Illinoisans.

On September 23, 2025, the Illinois Department of Public Health (IPDH) issued public guidance and a standing order to health care professionals advising which residents were recommended to receive immunizations against various illnesses: IDPH Issues Fall Vaccine Guidance and COVID-19 Standing Order to Ensure Access for Illinoisans. This includes COVID-19, respiratory syncytial virus (RSV), and influenza immunizations, as well as non-seasonal immunizations. 

The Illinois Department of Insurance (IDOI) published an emergency rule immediately preserving immunization coverage to the maximum extent possible under its authority at that time: C.B. 2025-18.

On December 2, 2025, the Governor signed into law HB 767 (Public Act 104-0439). Under this legislation, effective immediately, if the federal government or advisory panels rescind or revise vaccine guidance, Illinoisans with IDOI-regulated health insurance plans will still be able to receive immunizations without cost-sharing as long as they are included in IDPH’s State Guidelines.

All Illinoisans who have comprehensive health coverage that is fully or partially regulated by IDOI are protected by the State requirements now in force. These include fully-insured individual or group health insurance coverage and group health plans for State, county, municipality, and school district employees.

State requirements do not affect federal employee health benefits, self-funded (including “level-funded”) plans offered by some private employers, Medicare, U.S. military and veterans benefits, or plans for local government employees other than county, municipal, or school districts.

For questions about Medicaid coverage, please consult the website of the Illinois Department of Healthcare and Family Services.

Illinoisans with IDOI-regulated health insurance plans can continue to receive COVID-19, RSV, and influenza vaccines at no cost with no interruption in coverage for the same individuals. Children under the age of 4 will continue to be covered without cost-sharing regardless of whether the parents and health care provider choose the single combined measles, mumps, rubella, varicella (MMRV) vaccine or the two separate MMR and varicella vaccines. Healthy and stable infants within 24 hours of birth will continue to be covered for Hepatitis B vaccinations without cost-sharing. Other vaccines continue to be as previously listed on the CDC immunization schedules as of August 7, 2025.

*It is possible that individuals with coverage under a fully-insured group PPO plan from a private employer, or individuals with a self-funded State, county, municipal, or school district employee plan, will experience a brief gap in coverage for the single combined MMRV vaccine until mid-January 2026. If you have coverage under any of these types of plans and you are interested in the single combined MMRV vaccine, please contact your benefits administrator to learn whether it is covered in the meantime.

If you have an IDOI-regulated plan, your insurance card will list either “DOI” or “IL-DOI”. If you still have questions about whether you have an IDOI-regulated plan, please contact your plan issuer.

If you have an IDOI-regulated plan, there are no copayments, coinsurance, deductible, or out-of-pocket requirements for a routine vaccine and the vaccine’s administration if you receive the service from an in-network health care provider.

Illinoisans can receive immunizations at any location of their choosing. This includes a provider’s office, pharmacy, or clinic. If you need assistance finding a fall immunization provider, please visit the IDPH website: Vaccine Locator. If you need assistance locating a pharmacy that offers fall immunizations, please visit the CDC’s website: Find pharmacies near you.

NOTE: Please check your plan’s provider directory to confirm whether the location you selected is in-network for you. You may be required to pay a copayment, coinsurance, or part of your deductible if the location you visit is not in-network to your plan.

All Illinoisans are encouraged to receive fall immunizations as recommended by IDPH. IDPH issued a flyer with immunization recommendations: Immunization Recommendations for 2025-2026 Respiratory Virus Season.

You do not need a physician’s note to receive a seasonal respiratory virus immunization for COVID-19, RSV, or flu. You may need a physician’s note to receive non-seasonal immunizations.

IDPH has preserved the August 7, 2025 versions of the CDC immunization schedules for all immunizations, except to the extent that IDPH’s Respiratory Virus Season Guidance for Clinicians provides specific recommendations for COVID-19, influenza, and RSV:

·        Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger

·        Recommended Adult Immunization Schedule for Ages 19 Years or Older

On December 17, 2025, the Director of the Illinois Department of Public Health issued a State Guideline recommending that healthy and stable infants receive the Hepatitis B vaccination within 24 hours of birth. The full State Guideline is published here, which also affirms IDPH’s guidance from September 23 on other immunizations: Pediatric Hepatitis B Prevention Guidance and Reissuance of Prior Immunization Guidance for Clinicians.

If you do not have insurance, you have several options.

If you live in Chicago, the city offers free vaccines for children: Vaccines for Children Program.

IDPH’s website contains links to local resources for free or low-cost vaccines: Vaccine Locator.

Each county health department has resources for local residents: Local Health Departments.

Illinoisans without insurance can also visit a federally qualified health center (FQHC) to receive immunizations at little or no cost. You can find an FQHC at the HRSA website: Find a Health Center.

If you have a plan regulated by IDOI and experience an issue with immunization coverage, you can file a complaint with IDOI by calling 877-527-9431 or visiting the IDOI website at How to File a Complaint. IDOI is happy to assist with any consumer experiencing issues with their health coverage.