Flu vaccination rates in the U.S. vary dramatically by state — and where you live can directly affect your health risk and out-of-pocket costs this season. States like Vermont and Massachusetts consistently top the rankings, while Idaho and Mississippi sit near the bottom. Understanding your state’s standing helps you make smarter decisions about preventive care and health insurance coverage.
Which States Have the Highest and Lowest Flu Vaccination Rates in 2025
Flu vaccination rates vary widely across the U.S., with the gap between the highest and lowest states running more than 20 percentage points.
If you’ve ever wondered why your neighbor got a flu shot and you didn’t — or why some states seem to breeze through flu season while others get hammered — state-level vaccination rates are a big part of the answer. The gap between the top and bottom states runs more than 20 percentage points, which is not a small difference.
Why Flu Vaccination Rates Matter for Your Health and Your Wallet
Getting a flu shot isn’t just a personal health decision. It’s also a financial one. When large portions of a population skip vaccination, healthcare systems absorb higher costs, employers lose productivity, and individuals end up facing steep medical bills.
How Low Vaccination Rates Drive Up Health Insurance Costs
When flu cases spike in a state, emergency rooms fill up, urgent care centers get overwhelmed, and hospitalizations climb. Insurers respond to higher claims volume by adjusting premiums over time. States with chronically low vaccination rates tend to carry higher per-capita healthcare costs, which filters into what residents pay for coverage.
The Link Between Flu Shots and Preventive Care Coverage Under the ACA
Under the Affordable Care Act, all ACA-compliant health plans must cover flu shots at zero cost to you — no copay, no deductible. This is one of the most straightforward preventive benefits in American insurance law. Yet millions of insured Americans still don’t take advantage of it. If you’re comparing plans this open enrollment season, confirming that preventive care is fully covered should be at the top of your checklist.
Flu Vaccination Rates by State: 2025 National Overview
Before diving into which states lead and which lag, it helps to understand how this data is gathered and what it actually measures.
How We Compiled This Data
This article draws on federal surveillance programs that track flu vaccination coverage across the country every season. The data is publicly available but requires some interpretation.
Data Sources: CDC FluVaxView, BRFSS, and State Health Departments
The primary source is the CDC’s FluVaxView program, which publishes state-level flu vaccination estimates each season based on survey data. The Behavioral Risk Factor Surveillance System (BRFSS), run by the CDC in partnership with state health departments, provides additional adult vaccination prevalence data. Some states also publish their own health department reports that supplement federal estimates.
Methodology: Adults 18 Plus and Children 6 Months and Older
Flu vaccination rate data covers two main populations: adults 18 and older, and children 6 months and older (the minimum age at which flu vaccination is recommended). The numbers below reflect the 2024–2025 flu season estimates published in spring 2025. Because survey-based data has a natural lag, figures represent completed-season coverage rather than real-time counts.
National Average Flu Vaccination Rate in 2025
The national flu vaccination rate for adults in the 2024–2025 season was 41.9 percent, according to CDC FluVaxView — down 3.0 percentage points from 44.9 percent the prior season. For children, the rate is somewhat higher, reflecting stronger pediatric vaccination infrastructure and the Vaccines for Children (VFC) program.
Year-Over-Year Trend: 2020 Through 2025
Flu vaccination rates spiked during the 2020–2021 season as COVID-19 awareness drove more Americans toward all forms of preventive healthcare. Rates have since moderated but remain above pre-pandemic baselines in most states. The trend line from 2020 to 2025 shows modest improvement nationally, though progress has stalled in several Southern and rural states.
How the United States Compares to Other Developed Nations
The U.S. adult flu vaccination rate trails several peer nations, including the United Kingdom and Australia, which have achieved higher population coverage through national health service delivery models. The Healthy People 2030 target set by HHS calls for 70 percent of U.S. adults to receive annual flu vaccination — a benchmark most states have not yet reached.
States With the Highest Flu Vaccination Rates
Some states have built vaccination ecosystems that genuinely work. Here’s what the top performers look like and what they’re doing differently.
Top 10 States for Flu Vaccination Coverage
Based on CDC FluVaxView 2024–2025 season data, the states with the highest adult flu vaccination rates include:
|
Rank |
State |
Estimated Adult Flu Vax Rate |
|---|---|---|
|
1 |
Vermont |
58.0% |
|
2 |
Massachusetts |
55.2% |
|
3 |
Maine |
52.7% |
|
4 |
Rhode Island |
52.4% |
|
5 |
New Hampshire |
50.8% |
|
6 |
Maryland |
49.2% |
|
7 |
Minnesota |
47.4% |
|
8 |
Delaware |
47.4% |
|
9 |
Hawaii |
47.3% |
|
10 |
Connecticut |
47.0% |
Number One State: Key Drivers Behind the High Rate
Vermont led every state in 2024–2025 at 58.0 percent adult coverage. The state combines one of the lowest uninsured rates in the country, expanded Medicaid, and active state health department outreach campaigns. Its relatively small, coordinated population makes consistent public health messaging easier to run, and despite rural geography its pharmacy and primary-care networks keep a flu shot within easy reach. Residents with health insurance benefit from preventive care networks that make getting vaccinated genuinely convenient.
What High-Performing States Have in Common
Across the top 10, a few patterns show up repeatedly:
- Medicaid expansion: Every top-10 state has expanded Medicaid under the ACA, giving low-income residents cost-free access to flu vaccination.
- High insurance coverage rates: Fewer uninsured residents means more people with plans that cover flu shots at zero cost.
- Urban and suburban pharmacy density: High-performing states have more pharmacies per capita, reducing the access barrier.
- Strong public health infrastructure: State health departments in these states run consistent, well-funded outreach programs.
Role of Employer Wellness Programs and State Mandates
Several top-performing states have sizable employer bases that run formal wellness programs — often including on-site or subsidized flu shot clinics. Massachusetts, for example, has a long history of employer health mandate policy that encourages preventive care culture. Massachusetts health insurance plans frequently include wellness incentives tied to vaccination completion.
Regional Patterns Among Top-Performing States
Northeast Dominance: Why New England Leads
Six of the top 10 states are in New England or the broader Northeast. This region has the highest rates of health insurance coverage in the country, the densest pharmacy networks, and state governments with long track records of proactive public health policy. Connecticut health insurance markets, for instance, are among the most competitive in the ACA exchange system, which drives plan quality upward.
Upper Midwest Performers and What Sets Them Apart
Minnesota, Wisconsin, and Iowa punch above their weight in flu vaccination. These states benefit from strong community health center networks, high rates of employer-sponsored insurance, and cultural norms around preventive healthcare that researchers have documented across multiple vaccination types — not just flu.
States With the Lowest Flu Vaccination Rates
Now for the harder conversation. Several states have struggled to move the needle on flu vaccination for years, and the reasons are structural, not incidental.
Bottom 10 States for Flu Vaccination Coverage
|
Rank |
State |
Estimated Adult Flu Vax Rate |
|---|---|---|
|
41 |
Florida |
36.6% |
|
42 |
Utah |
36.4% |
|
43 |
Oklahoma |
36.3% |
|
44 |
Texas |
35.7% |
|
45 |
Wyoming |
35.4% |
|
46 |
California |
35.2% |
|
47 |
Alabama |
32.5% |
|
48 |
Nevada |
31.4% |
|
49 |
Mississippi |
28.5% |
|
50 |
Idaho |
27.3% |
The Lowest-Ranked State: Contributing Factors
Idaho posted the lowest adult flu vaccination rate at 27.3 percent. Notably, Idaho is not a Medicaid-access story — the state expanded Medicaid in 2020, so coverage gaps are less the driver here than in the Southern states just above it. Idaho’s low rate tracks more closely with elevated vaccine hesitancy, a dispersed rural population with real pharmacy-access gaps, and lower overall preventive-care utilization. Just above Idaho sits Mississippi (28.5 percent), where the more familiar combination applies — among the highest uninsured rates in the country, non-expansion of Medicaid, and thin rural pharmacy infrastructure. These aren’t excuses — they’re structural realities that public health officials have flagged for years.
Common Barriers in Low-Performing States: Access, Cost, and Hesitancy
Low-performing states share three overlapping barriers:
- Cost: Without insurance or Medicaid coverage, a flu shot can cost $25–$50 out of pocket at retail pharmacies — not catastrophic, but enough to be a barrier for low-income households.
- Access: Rural residents may live 30 or more minutes from the nearest pharmacy or clinic.
- Hesitancy: Vaccine hesitancy — accelerated by misinformation that intensified during the COVID-19 pandemic — remains elevated in several Southern and Mountain West states.
Regional Patterns Among Lowest-Performing States
Southern States and Persistent Coverage Gaps
The bottom 10 splits between the South — Mississippi, Alabama, Texas, Oklahoma, and Florida — and the Mountain West — Idaho, Nevada, Wyoming, and Utah — with California rounding it out. The Southern states in this group combine the highest uninsured rates and the most non-Medicaid-expansion states with significant rural healthcare deserts. The Mountain West states skew more toward vaccine hesitancy and rural pharmacy access than toward insurance gaps. Across both regions, comparing health insurance options is one lever residents can control even where the structural barriers are real.
Rural Access Challenges and Pharmacy Desert Impact
In counties where the nearest pharmacy is more than 15 miles away, flu vaccination rates are measurably lower. This “pharmacy desert” problem is most acute in rural Mississippi, Arkansas, and Wyoming. Without a convenient vaccination site, even motivated individuals face real logistical barriers.
Full State-by-State Flu Vaccination Rate Rankings: 2025
Interactive Data Table: All 50 States Plus Washington DC
The table below reflects 2024–2025 season CDC FluVaxView estimates for adults 18 and older. States are ranked from highest to lowest vaccination rate.
|
Rank |
State |
Adult Flu Vax Rate (%) |
Medicaid Expanded? |
|---|---|---|---|
|
1 |
Vermont |
58.0% |
Yes |
|
2 |
District of Columbia |
57.9% |
Yes |
|
3 |
Massachusetts |
55.2% |
Yes |
|
4 |
Maine |
52.7% |
Yes |
|
5 |
Rhode Island |
52.4% |
Yes |
|
6 |
New Hampshire |
50.8% |
Yes |
|
7 |
Maryland |
49.2% |
Yes |
|
8 |
Minnesota |
47.4% |
Yes |
|
9 |
Delaware |
47.4% |
Yes |
|
10 |
Hawaii |
47.3% |
Yes |
|
11 |
Connecticut |
47.0% |
Yes |
|
12 |
Washington |
46.5% |
Yes |
|
13 |
Colorado |
46.1% |
Yes |
|
14 |
North Carolina |
45.6% |
Yes |
|
15 |
Virginia |
45.5% |
Yes |
|
16 |
New York |
44.8% |
Yes |
|
17 |
Wisconsin |
44.8% |
No |
|
18 |
Oregon |
44.8% |
Yes |
|
19 |
Pennsylvania |
44.6% |
Yes |
|
20 |
South Dakota |
43.5% |
Yes |
|
21 |
Illinois |
42.8% |
Yes |
|
22 |
Iowa |
42.4% |
Yes |
|
23 |
New Mexico |
42.3% |
Yes |
|
24 |
New Jersey |
42.2% |
Yes |
|
25 |
Ohio |
42.0% |
Yes |
|
26 |
Nebraska |
41.9% |
Yes |
|
27 |
Kansas |
41.6% |
No |
|
28 |
Kentucky |
41.0% |
Yes |
|
29 |
West Virginia |
41.0% |
Yes |
|
30 |
Michigan |
40.7% |
Yes |
|
31 |
North Dakota |
40.2% |
Yes |
|
32 |
South Carolina |
39.4% |
No |
|
33 |
Missouri |
39.0% |
Yes |
|
34 |
Tennessee |
38.4% |
No |
|
35 |
Montana |
38.0% |
Yes |
|
36 |
Indiana |
37.6% |
Yes |
|
37 |
Alaska |
37.5% |
Yes |
|
38 |
Arkansas |
37.0% |
Yes |
|
39 |
Louisiana |
36.9% |
Yes |
|
40 |
Arizona |
36.7% |
Yes |
|
41 |
Georgia |
36.6% |
No |
|
42 |
Florida |
36.6% |
No |
|
43 |
Utah |
36.4% |
Yes |
|
44 |
Oklahoma |
36.3% |
Yes |
|
45 |
Texas |
35.7% |
No |
|
46 |
Wyoming |
35.4% |
No |
|
47 |
California |
35.2% |
Yes |
|
48 |
Alabama |
32.5% |
No |
|
49 |
Nevada |
31.4% |
Yes |
|
50 |
Mississippi |
28.5% |
No |
|
51 |
Idaho |
27.3% |
Yes |
Source: CDC FluVaxView, 2024–2025 season, adults 18+ (season-final cumulative estimate). Includes the 50 states + Washington, DC.
How to Read the Rankings Table
The vaccination rate column reflects the percentage of adults who self-reported receiving a flu shot during the 2024–2025 season (CDC FluVaxView, season-final cumulative). The Medicaid-expansion column is included to show structural context — it’s not the only factor, but coverage access is consistently correlated with vaccination rates.
Footnotes on Data Lag and Reporting Periods
CDC FluVaxView data for a given flu season is typically finalized in spring of the following year. The 2024–2025 season figures used here reflect estimates published in spring 2025. BRFSS data, used for supplemental figures, may reflect a slightly different reporting window.
What Drives Flu Vaccination Rates Up or Down by State
Access to care, income levels, and local public health campaigns are the main factors, with rural areas and uninsured populations typically showing lower vaccination rates.
Factors That Increase Vaccination Rates
Medicaid Expansion and Zero-Cost Flu Shot Access
States that expanded Medicaid under the ACA gave low-income adults access to flu shots at zero out-of-pocket cost. This single policy decision is one of the strongest predictors of higher vaccination rates at the state level. Our Medicaid eligibility guide explains how to check whether you qualify.
State-Level Public Health Campaigns
States that invest in sustained, year-round vaccination outreach — not just October reminders — see higher uptake. Rhode Island and Minnesota both run well-funded public health campaigns that include multilingual materials, community partnerships, and employer engagement.
Employer-Sponsored Health Plan Incentives
Many large employers in high-performing states offer on-site flu clinics or financial incentives (premium discounts, HSA contributions) tied to flu vaccination. This makes vaccination a default rather than an extra step.
Factors That Decrease Vaccination Rates
Vaccine Hesitancy and Misinformation Trends in 2025
Vaccine hesitancy that intensified during COVID-19 has carried over into flu shot reluctance in some communities. Survey data shows that trust in vaccine safety and efficacy remains lower in states with the lowest flu vaccination rates.
Rural Provider Shortages and Transportation Barriers
In states with large rural populations, provider shortages mean fewer places to get vaccinated. Transportation barriers — lack of a car, long distances, no public transit — compound the problem significantly.
Underinsured and Uninsured Populations
Even when flu shots are free under ACA-compliant plans, people without insurance don’t have that coverage. States with high uninsured rates consistently show lower vaccination uptake. If you’re currently uninsured, a short-term health insurance plan or Medicaid may cover preventive care — it’s worth checking.
The Cost of Flu Season: What Low Vaccination Rates Mean for Consumers
If you skip the flu shot and get sick, the financial exposure ranges from modest to genuinely serious.
Average Cost of Flu Treatment Without Insurance in 2025
Urgent Care Visit Costs for Flu: $150 to $250
A standard urgent care visit for flu symptoms — exam, possibly a rapid flu test, maybe an antiviral prescription — runs $150 to $250 without insurance, based on FAIR Health 2025 cost benchmarks. That’s before the cost of the antiviral medication itself.
ER Visit Costs for Flu Complications: $1,000 to $3,500
If your flu progresses to pneumonia or severe dehydration and you end up in the emergency room, costs jump sharply. An ER visit for flu complications averages $1,000 to $3,500 without insurance — and that’s for a visit that doesn’t result in a hospital bed.
Hospitalization Costs for Severe Influenza: $5,000 to $20,000 or More
CDC’s FluSurv-NET data and hospital billing records consistently show that inpatient hospitalization for severe influenza runs $5,000 to $20,000 or more, depending on length of stay and complications. For someone without coverage, that’s a financial event that can take years to recover from.
If you’re shopping for health insurance and want to make sure you’re protected against exactly this kind of cost, comparing health insurance plans in your state is a smart place to start.
How Your State Affects Your Out-of-Pocket Flu Risk
States With Higher Uninsured Rates Face Greater Financial Exposure
In Mississippi, Louisiana, and Texas, uninsured rates run significantly higher than the national average. Uninsured residents who develop severe flu have no coverage cushion — they absorb the full cost of any treatment. Texas health insurance options through the ACA marketplace are available even if your employer doesn’t offer coverage.
How Health Insurance Covers Flu Shots and Flu-Related Care
ACA-compliant plans cover the flu shot itself at zero cost. Flu treatment — urgent care, ER, hospitalization — is subject to your deductible and copay structure. That’s why having a plan with manageable cost-sharing matters.
Flu Vaccination as a Preventive Benefit: What Your Plan Covers
ACA-Compliant Plans Must Cover Flu Shots at Zero Cost
The ACA’s preventive care mandate requires all non-grandfathered health plans to cover recommended vaccines — including the annual flu shot — without any cost-sharing. You don’t pay a copay. You don’t apply it to your deductible. It’s free. Our preventive care coverage explainer walks through what else this mandate covers.
Medicare Part B and Flu Shot Coverage in 2025
Medicare Part B covers one flu shot per season at zero cost when you use a Medicare-enrolled provider. There’s no deductible or coinsurance for this benefit. Our Medicare Part B overview has more on what the benefit covers and how to use it.
Medicaid Flu Shot Coverage by State
All state Medicaid programs cover flu vaccination, though benefit structures vary. In Medicaid expansion states, coverage is broader and cost-sharing is minimal or zero for most enrollees.
How to Get a Free or Low-Cost Flu Shot in Any State
Your local pharmacy, community health clinic, or doctor’s office can get you a flu shot at little or no cost, and most insurance plans cover it fully.
Where to Get Vaccinated in 2025
Retail Pharmacies: CVS, Walgreens, Walmart, and Costco
Retail pharmacies are the most convenient vaccination sites for most Americans. CVS, Walgreens, Walmart, and Costco all offer flu shots, and all will bill your insurance directly. If you have ACA-compliant coverage, Medicare Part B, or Medicaid, your shot is free. Walk-ins are generally welcome; appointments are available online.
Federally Qualified Health Centers and Community Clinics
HRSA-funded Federally Qualified Health Centers (FQHCs) serve patients regardless of their ability to pay, using sliding-scale fees. These centers are specifically designed to reach underinsured and uninsured populations and are distributed across both urban and rural areas.
State and County Health Department Flu Clinics
Many state and county health departments run seasonal flu shot clinics, often at no charge. Check your state health department’s website for dates and locations — these clinics are frequently available in communities with limited pharmacy access.
What to Do If You Are Uninsured or Underinsured
VFC Program for Children and HRSA-Funded Clinics for Adults
The Vaccines for Children (VFC) program provides free flu vaccines to children who are uninsured, underinsured, Medicaid-eligible, or Alaska Native/American Indian. For adults without insurance, HRSA-funded health centers offer low-cost or free vaccination on a sliding scale.
How to Find Free Flu Shots Using Vaccines.gov
Vaccines.gov is the federal government’s official vaccine finder tool. Enter your zip code, select the flu vaccine, and it will show you nearby locations with availability and cost information. It’s the fastest way to find a free or low-cost shot near you, regardless of your state.
Frequently Asked Questions About Flu Vaccination Rates by State
Which state has the highest flu vaccination rate in 2025?
Vermont leads all 50 states in adult flu vaccination, covering 58.0 percent of adults in the 2024 to 2025 season, per CDC FluVaxView estimates.
Vermont ranks first among all 50 states for adult flu vaccination coverage in the 2024–2025 season at 58.0 percent, according to CDC FluVaxView estimates. (Washington, DC, is fractionally higher at 57.9 percent but isn’t a state.) Vermont benefits from near-universal insurance coverage, expanded Medicaid, and sustained public health outreach. Massachusetts (55.2 percent) and Maine (52.7 percent) follow. These states have strong ACA marketplace enrollment and high rates of employer-sponsored insurance.
Which state has the lowest flu vaccination rate in 2025?
Idaho has the lowest adult flu vaccination rate at 27.3 percent, with vaccine hesitancy, rural pharmacy access gaps, and low preventive-care use all playing a role.
Idaho ranks last among all 50 states for adult flu vaccination coverage at 27.3 percent. Contributing factors lean toward vaccine hesitancy, a dispersed rural population with limited pharmacy access, and lower preventive-care utilization — notably, Idaho expanded Medicaid in 2020, so insurance access is less the driver here than in the Southern states near the bottom. Mississippi (28.5 percent) and Nevada (31.4 percent) also rank near the bottom.
Are flu shots free under health insurance?
Most ACA-compliant health plans cover your annual flu shot at zero cost, meaning no copay and no deductible. Medicare Part B and Medicaid also cover flu shots, though Medicaid cost-sharing rules vary by state.
Yes — if your plan is ACA-compliant. The Affordable Care Act requires all non-grandfathered health plans to cover recommended vaccines, including the annual flu shot, at zero cost to you. No copay, no deductible. Medicare Part B also covers one flu shot per season at zero cost. Medicaid covers flu shots in all states, though cost-sharing rules vary.
What is the national flu vaccination rate for adults in 2025?
The national adult flu vaccination rate for the 2024–2025 season was 41.9 percent (CDC FluVaxView), down from 44.9 percent the prior season. This figure represents self-reported vaccination through the end of the flu season. The HHS Healthy People 2030 target is 70 percent coverage for adults — a benchmark most states have not yet reached.
How do flu vaccination rates affect health insurance premiums?
Higher vaccination rates mean fewer flu-related ER visits and hospitalizations, which lowers insurer costs and can moderate premium growth over time in your state.
Higher flu vaccination rates reduce the number of flu-related urgent care visits, ER visits, and hospitalizations in a state. Fewer claims mean lower aggregate costs for insurers, which can moderate premium growth over time. States with low vaccination rates tend to have higher healthcare utilization during flu season, which contributes to upward pressure on premiums over multi-year cycles.
Where can I find historical flu vaccination rate data by state?
The CDC’s FluVaxView program publishes state-level flu vaccination estimates for each flu season going back to the mid-2000s. The BRFSS database, also maintained by the CDC, provides additional adult vaccination prevalence data with state-level breakdowns. Both tools are free and publicly accessible at cdc.gov.
Conclusion: Know Your State, Protect Your Health, and Review Your Coverage
Flu vaccination rates tell a story about access, policy, and health infrastructure — not just personal choices. If you live in a high-performing state like Rhode Island or Massachusetts, you have a robust safety net of coverage options and vaccination sites. If you’re in Mississippi, Louisiana, or another low-performing state, the structural barriers are real, but free and low-cost options still exist through FQHCs, health department clinics, and Vaccines.gov.
The flu shot itself is free under virtually every ACA-compliant plan, Medicare Part B, and most Medicaid programs. The bigger risk is not having coverage at all when flu turns serious — and in low-vaccination states, serious flu is more likely because community protection is lower.
Before flu season peaks, it’s worth a few minutes to check whether your current plan covers preventive care, and if you’re uninsured or underinsured, to compare your options. Simply Insurance may receive compensation when readers click partner links and an eligible action is approved — but the core advice here is the same either way: a flu shot costs you nothing if you have the right plan, and finding that plan takes less time than you think.