What Is The Flu
The flu, short for influenza, is a respiratory illness caused by influenza viruses, which can infect your nose, throat and lungs. The flu is contagious, infecting between 5 percent and 20 percent of the American population each year, according to the Centers for Disease Control and Prevention. It’s typically transmitted by droplets emitted when an infected person coughs or sneezes. If you inhale those droplets, you may become sick. Likewise, if the droplets land on an object that you touch, the virus can then be inhaled or ingested if you put your hands near your nose or mouth. Flu season in the United States typically lasts from October to May, and peaks in January or February.
Some cases of the flu can be severe. “A lot of times, we think of the flu as a mild disease, but people die from the flu and flu-related complications,” says Dr. Ajani Nimmagadda, a senior medical director at Cigna. In the U.S., on average, more than 200,000 people must be hospitalized each year because of flu-related complications. The number of flu-related deaths in the U.S. in a given year has ranged from 3,000 to about 49,000.
Other flu symptoms include fever, cough, sore throat, fatigue and a runny or stuffy nose. Complications of the flu include pneumonia, sinus infections and dehydration. The flu can also worsen some chronic medical conditions, such as asthma, diabetes and congestive heart failure.
Certain people are more at risk of suffering complications from the flu, including:
How Much Will I Pay For The Flu Vaccine At A Local Pharmacy
*Medicare members with Part D and Part B benefits with EmblemHealth. Please note: Medicare members with Part D benefits with EmblemHealth, but no Part B benefits, cannot get the flu vaccine at a network pharmacy. Those members should contact their Part B carrier for coverage of the flu vaccine.
You must continue to pay your Medicare Part B premium.
To find a nearby location that participates in the EmblemHealth vaccine program:
- Search for an EmblemHealth network pharmacy by clicking on the Find a Pharmacy link.
- Call our Flu Information Line at 877-859-9001 . Our hours are 8 a.m. to 8 p.m., Monday to Friday.
Contact your network pharmacy ahead of time to make sure the vaccine is available, learn about any age restrictions, and find out the times they are giving vaccines. Also, dont forget to present your member ID card to the pharmacist at the time of service.
Learn more about the flu vaccine by reading Flu Facts: Frequently Asked Questions.
Does Insurance Cover Flu Shots And Other Flu Season Answers
Flu season is nothing to sneeze at.
The Centers for Disease Control , estimate that last years flu season resulted in:
- 39 to 56 million flu cases
- 18 to 26 million doctors office visits for the flu
- 410,000 to 740,000 flu-related hospitalizations
- 24,000 to 62,000 flu deaths
And theres another complication to consider during the 2020-2021 flu season: the ongoing COVID-19 epidemic in the United States.
To learn more about COVID-19 and the flu and get answers to questions like Whats the difference between the flu and COVID-19? and Can you get COVID-19 and the flu at the same time? please check out the blog post, .
In the remainder of this post, well cover just about everything to know about flu season, including:
- Flu prevention
- Young children
View a detailed list of health and age factors that are known to increase a persons risk of serious flu complications.
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What Does Masshealth Cover For Flu Vaccines
MassHealth pays for administration of flu vaccines when LPHDs and PSDs provide MDPH-supplied flu vaccines to eligible MassHealth members up to and including 18 years of age. In addition, MassHealth pays LPHDs for purchasing and administering flu vaccines for eligible MassHealth members 19 years of age and older. For more information, please see the Physician Subchapter 6.
How Child Flu Vaccine Rates Relate To Lack Of Health Insurance
We conducted a study on flu vaccination rates and how they relate to health insurance coverage. We found that states with a high percentage of uninsured people have low flu vaccine rates. The inverse is also true: states where more residents have health insurance coverage have higher flu vaccine rates.
- Kaiser Family Foundation estimates nearly 1.5 million teachers are at greater risk of serious illness from COVID-19.
- Child influenza vaccination rates have declined during the COVID-19 pandemic by an estimated 21.5% from January to April 2020.
- Anticipating the double whammy of influenza season and COVID-19, the CDC is giving $140 million to immunization programs.
- The national average rate of vaccinated children in the United States is 58%.
- During the coronavirus pandemic, New York City saw vaccination rates drop 63% 91% for kids older than two.
- Rhode Island, Massachusetts and Connecticut have the highest rates of vaccinated children. Wyoming, Florida and Utah have the lowest rates.
During the month of May, New York City saw all child vaccinations drop 63% overall with a 91% drop for children ages two and over. This massive decline in flu shots and vaccinations was caused by the coronavirus pandemic. The 10% of Americans without health insurance will likely face a challenge to find an inexpensive way to vaccinate their children.
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Seasonal Flu Coverage And Benefits
One of the most important steps you can take to protect your health and well-being is to get an annual flu shot. Each year thousands of people are hospitalized because of complications from the flu. Thats why we encourage all our members to get their yearly flu vaccination.
Most Independence Blue Cross members with prescription drug coverage will pay $0 for a flu shot at an in-network pharmacy or provider.¹ Members will not need a referral, precertification, or preapproval to get their seasonal flu vaccine.
Whether in or outside of our service area, members should be able to receive a flu shot from in-network providers without having to pay upfront or submit a form for reimbursement.
Find an in-network provider
To find an in-network pharmacy or provider near you, log in at ibx.com.
Please note: For members who have 100 percent coverage for services in accordance with the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010, no cost-share should be applied for the vaccine and administration of the vaccine when it is administered by an in-network provider.
Coverage is subject to the terms and conditions of the applicable benefit plan. Individual benefits must be verified.
Why Does Health Insurance Cover Flu Shots And Other Vaccines
Most health insurance plans cover flu shots and other kinds of vaccinations because they keep people healthy and they keep people from dying.
They also help insurance companies save money. Specifically, vaccines and immunizations save insurers money by keeping people from developing illnesses and diseases that could cost them a lot more in the long run.
Another reason many health plans cover various vaccines and immunizations is that the ACA requires them to do so.
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Health Insurance Other Products To Help During Flu Season
Remember, ACA annual open enrollment begins November 1 for coverage effective January 1.
Open enrollment is an opportunity to obtain a health insurance plan that covers vaccinations at no additional out-of-pocket cost, including influenza immunization. These benefits apply to children and adults.
Plans also include benefits for a range of healthcare services that may be needed to help treat the flu, including doctors office visits, hospitalization, and emergency care.
These benefits are especially important to ensure you receive timely care in the event you develop serious flu-related health complications as treatment can be expensive.
Average costs for flu-related treatment:
- Flu testing and treatment at the doctors office: $147
- Flu testing and treatment at the walk-in clinic: $99
- Hospitalization for pneumonia: $5,016 to $15,675
- Emergency room visit for a moderate problem: $538 to $1,679
Does Medicaid Cover Flu Shots And Other Vaccines
Medicaid covers all recommended vaccines for children and some vaccines for adults.
It’s difficult to say which vaccines Medicaid covers for adults because every state handles Medicaid differently. That said, most state Medicaid agencies help pay for flu, Hepatitis B and pneumococcal shots in certain circumstances.
Unlike Medicare, Medicaid doesn’t always cover vaccines in full. Depending on where you live and where you get your shot, you may be responsible for a copayment or similar fee.
To find out if Medicaid covers any of the shots of vaccines you need, contact your local agency.
As for children, Medicaid mainly covers their shots and vaccines through the Children’s Health Insurance Program . For more information on the specific immunizations CHIP covers, contact your local agency.
There’s another way to get kids free or low-cost vaccines if your local Medicaid or CHIP program won’t cover them. The Vaccines for Children program provides vaccines to children whose parents or guardians can’t afford them.
To qualify, the child has to be younger than 19 years of age. He or she also needs to be one of the following:
- American Indian or Alaska Native
In this case, underinsured means your child has health insurance, but it doesn’t cover the shots or vaccines he or she needs.
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What’s The Best Way To Protect Yourself From The Flu
Its important to get the flu shot every year. The flu shot protects you against the flu virus.
It can help you prevent a hospitalization or complications of actually getting the flu.
It is very easy to find a local pharmacy or your providers office. Its offered in multiple, multiple locations.
Not only that, its also covered at 100% in most plans.
Plans Not Regulated By The Aca
The vaccine coverage requirement does not apply to plans that are not regulated by the ACA. These include:
At least 3 million Americans have coverage under short-term health plans, while 1.5 million are enrolled in healthcare sharing ministry plans.
Although some non-ACA-regulated insurers may agree to voluntarily include COVID-19 vaccination in their benefits, be aware that they may or may not fully waive cost-sharing.
Liberty HealthShare, one of the most popular healthcare sharing ministry plans, is one such example, having already stated that vaccine costs will be shareable. Other ministry plans have done the same, sometimes requiring members to meet their normal “annual unshared amount” before the vaccine cost is shared.
If you’re covered under any of these plans, reach out to the company to see if and how they will cover the cost of a COVID-19 vaccination.
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Will My Health Insurance Cover Flu Shots And Vaccinations
Updated on Tuesday, June 23 2020| by Bryan Ochalla
Most health plans cover flu shots and other vaccines, including employer, marketplace, Medicare and Medicaid plans.
If you have health insurance, it likely covers at least a few immunizations or vaccines.
This is true if you get your health coverage from an employer, an insurance company directly, the federal or state “marketplace,” Medicare or Medicaid. And QuoteWizard research found that having health insurance increases vaccination rates.
Not all health plans cover these shots in the same way or to the same extent, however. Some cover any vaccination you might need. Others only cover a handful.
Also, you don’t have to pay a dime to get immunized with some health plans. With others, you’re responsible for copayments or coinsurance costs.
In this article, youll learn all about:
Where Can I Get More Information
Your doctor or pharmacist can provide more information about this vaccine. Additional information is available from your local health department or the Centers for Disease Control and Prevention.
Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
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No One Likes Getting Sick
And the flu virus changes every year. So, getting a yearly shot helps protect yourself and those around you. Plus, its available at no cost to you. And getting your flu shot may actually earn you rewards.
The flu shot is a good idea for just about everyone. But these people are at an even higher risk of health problems from the flu:
Do Medicare Advantage And Medicare Supplement Plans Cover The Flu Shot
Medicare Advantage plans, which are often referred to as Medicare Part C, are offered by private insurance companies and typically include Part D, or prescription drug coverage. These plans provide a way to get additional Medicare benefits based on your individual needs.
Medicare Advantage plans cover 100% of the Medicare-approved amount for an annual flu shot, says Christian Worstell, a North Carolina-based licensed insurance agent. Plus, he notes, Medicare beneficiaries with a Medicare Advantage plan typically wont have to pay a coinsurance or copayment for the flu shot. Thats true as long as you visit a doctor who accepts Medicare and the terms of your Medicare Advantage plan, he says.
Meanwhile, Medicare Supplemental plansalso known as Medigap plansare designed to fill in the gaps of Original Medicare and provide you with supplementary coverage you might need. Since Original Medicare already covers the flu shot, you dont need to use a Medigap plan to help pay for it.
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Questions About The Seasonal Flu Shot Program
In most cases, you can get a flu shot at no charge if you have one of these plans: 5
- Blue Cross NC plans with preventive care benefits
- Blue Medicare HMOSM, PPOSM or SupplementSM
- North Carolina State Health Plan
- North Carolina Federal Employee Program
Where can I get a flu shot that’s covered?
You can get a flu shot during flu season at: 6
- Worksite clinics Some members may be able to get a flu shot where they work. Many employers have free on-site flu shot clinics. Employers may also let family members come to the flu clinic. Participants must be over 18. You can ask your Human Resources manager for more information.
- Doctor’s offices You can make an appointment for a flu shot or go to a doctor’s scheduled flu clinic. If you get other medical care in the same visit, you will have to pay a fee . Don’t have a doctor? Visit Find a doctor.
- Flu shots can now also be covered under the member’s Prime pharmacy benefits on most Blue Cross NC plans. Members just need to show their ID card at the pharmacy. These vaccines will be covered at 100% under their Prime pharmacy benefits.The following plans are excluded from coverage of the flu shot under the member’s pharmacy benefits: The State Health Plan Medicare Part D plans Members on these plans must continue to use one of the other flu shot options, and their medical benefits will apply.
Why can’t all pharmacists give flu shots?
How do I know if I’m able to get a flu shot at no charge?
Who should get a flu shot?
Do You Need A Flu Shot This Year
According to the Centers for Disease Control and Prevention , people over the age of 65 are at a very high risk of developing dangerous complications from the flu.1 If you are over 65 years old and/or have autoimmune issues , getting your Medicare-covered flu vaccine is your best defense at protecting you from the flu or lessening the effects of it.
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Where Do I Get A Flu Shot Is It Safe To Go Out And Get One
Some settings, like workplaces, may not offer the flu vaccine this year. However, you can safely get a flu shot during COVID-19 by practicing preventive actions like wearing a mask and social distancing. In addition, most doctors offices and pharmacies have taken precautionssuch as scheduling appointment times to manage patient flow and allowing for a minimum distance of six feet between patients in waiting areas.
To locate a flu shot provider near you, use Find a Doctor. Choose Medical, and then select Immunizations: Flu shot. Be sure to sign in, so your results are in-network. Many pharmacies offer walk-in vaccinations, so you dont need to make an appointment.
If youd rather get your flu shot at your doctors office, reach out to your primary care provider. Remember to ask them if walk-in immunizations are available to avoid paying for an office visit along with your flu shot.
Masshealth Adult Vaccine Component
When LPHDs purchase adult vaccines for patients 19 years of age and older, MassHealth will pay the LPHDs for purchasing and administering the vaccines at fee-for-service rates. MassHealth will not pay for a MassHealth member enrolled in an MCOsuch claims must be submitted to the respective MCOs.
To find the reimbursable vaccines, please review the Physician Subchapter 6.
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What Do I Need To Know About Flu Shots
Who is this for?
Blue Cross Blue Shield of Michigan and Blue Care Network members under age 65. If you’re a Medicare member, please visit our Medicare flu and pneumonia shots page to learn more.
There’s never been a more important time to get your flu shot. You can learn about it here. You might also want to know the symptoms of the flu versus COVID-19.