Confused about who can get a Covid vaccine, whether you need a prescription, and if your insurance will cover it? You’re not alone. We spoke with numerous health experts and pharmacies, and here’s the bottom line: The Trump administration isn’t restricting who can get a shot—at least for now—and local authorities in DC, Maryland, and Virginia have updated their rules so residents who want the vaccine can still roll up their sleeves.
In late August, the Food and Drug Administration narrowed approval of the updated Covid vaccine to adults 65 and older, along with younger people with at least one high-risk condition. The move sparked pushback from the American Academy of Family Physicians and the Infectious Diseases Society of America, and prompted regional officials to take action to keep the vaccine available.
Then last week, the CDC’s vaccine advisory panel, ACIP, added another layer of complexity: It dropped its universal recommendation that everyone 6 months and older get the shot, adopting instead “shared decision-making,” where the choice is left to patients and their doctors. The panel also rejected a proposal to require prescriptions. These recommendations still need formal sign-off from acting CDC Director Jim O’Neill before they take effect.
Who can get the shot?
Where does this leave residents of DC, Maryland, and Virginia?
Earlier this month, Maryland and Virginia issued standing orders authorizing healthcare providers to administer the vaccine without a prescription. In Maryland, providers can vaccinate anyone 6 months or older, while pharmacists can give the shot to children as young as three. Virginia allows anyone over 18 to get vaccinated at a pharmacy without a doctor’s note.
Pharmacies in both states, like CVS, may still ask patients under 65 whether they meet one of the FDA’s eligibility criteria—which includes being “physically inactive,” or having diabetes, asthma, or a mental health condition—but they don’t require proof, according to CVS spokesperson Amy Thibault.
DC followed suit on Monday, when Mayor Muriel Bowser signed emergency legislation to allow residents to get vaccinated without a prescription and to let minors receive the shot for the next 90 days. Before that, many DC pharmacies were turning away patients, citing the FDA’s limited approval and requiring a doctor’s order for anyone under 65.
Even with the new rules, not everyone’s on the same page. CVS pharmacies across the DMV are giving shots to anyone 12 and up without a prescription, but our calls to five local Walgreens locations found that some are still telling patients they need a doctor’s note.
Are the shots free?
Although the CDC will no longer be recommending the Covid vaccine for everyone, America’s Health Insurance Plans (AHIP), the trade association covering most major insurers except United Healthcare, said last week that it will continue to cover the updated vaccine at no cost through the end of 2026. (Update: After this story originally published, United Healthcare responded to a query from Washingtonian, saying that it “will continue to cover claims” for the Covid vaccine “at $0 for our standard commercial plans….We recommend that members in self-insured employer sponsored plans always confirm their specific plan benefits.”)
“Health plans will continue to cover the Covid vaccines with no cost-sharing for patients, including those who are over 6 months in age without a health condition,” AHIP told Washingtonian. “Covid vaccines are currently covered by health plans, already in effect, and have been in effect.”
Still, it’s a good idea to check with your insurance company to confirm coverage. For those without insurance, CVS lists the cost at $224.99, according to Thibault.
How are experts reacting?
Dorit Rubinstein Reiss, a UC Hastings law professor who specializes in vaccine policy, says the CDC’s shift to shared decision-making could mean fewer people actually get vaccinated. She notes that some doctors may only bring it up if patients ask, and that uncertainty over eligibility and insurance coverage could keep others from getting the shot altogether.
“People are highly confused about the rules,” Reiss added. “The Health and Human Services press release suggests anyone who wants a Covid vaccine should get it, but that won’t necessarily translate on the ground. If people are uncertain if they can get their vaccine covered, they just won’t get it unless they really care about it.”
The American Academy of Family Physicians continues to recommend that all adults 18 and older get vaccinated, especially those 65 and older, at higher risk for severe Covid, and those who have never received a Covid vaccine.
“History shows us that vaccines have eradicated diseases that were disabling and deadly in the past, and we can keep it that way, if we continue to vaccinate,” said Margot Savoy, chief medical officer of the AAFP in a press release. “Protecting public health is our collective responsibility. This fall and always, the AAFP stands with our members and public health partners to promote vaccine confidence and uptake.”
