Does Insurance Cover Flu Shots?
An annual flu shot could mean the difference between a few days in bed and a trip to the hospital. The COVID-19 pandemic has created some confusion around administering both vaccines and flu shots, but experts predict that COVID-19 and the flu combined will cause significant disruption to the healthcare sector this year. To combat this, the CDC has pledged $140 million to support COVID-19 immunization programs for those covered by insurance, as well as those who aren’t. But what about the flu? Does insurance cover flu shots? The answer is not a straightforward one. If you’re wondering “does my insurance cover the flu shot?”, here’s what you need to know.
Does Health Insurance Cover Flu Shots?
A flu shot covered by insurance largely depends on your insurance plan. Flu shot insurance may provide you with a subsidized shot, but keep in mind there may be copays to consider. If you don’t have an insurance plan that covers the annual flu shot, how much is the flu shot without insurance? While costs differ nationwide and between providers, the average cost of a high-dose flu shot is $70. Let’s answer the question “does my insurance cover flu shots?” and how the answer may change depending on your insurance plan.
Employer Health Insurance
The majority of health insurance plans provided by employers will cover flu shots. In many cases, they will also cover other vaccines. It’s important to note that the Affordable Care Act (ACA) doesn’t require every employer health plan to do so. One glaring example where exceptions are made is with larger companies. Big companies are not required to meet all of the ACA’s requirements, but the majority do anyway. In all but the rarest of cases, employer health insurance will cover your annual flu shot.
Remember, under the ACA, mandated flu shot coverage cannot come with copays or coinsurance. However, you may need to attend a specific facility to receive your shot. Check with your insurance provider if this applies to you.
What about Grandfathered Health Plans?
Does insurance cover flu shots for grandfathered employer health plans? Grandfathered health plans are insurance plans that existed before the ACA entered into law. Insurers cannot make significant changes to their coverage if they want to maintain their grandfathered status. So, if your grandfathered plan previously covered the annual flu shot, it still will today. On the other hand, grandfathered plans without this coverage are unlikely to provide flu vaccine coverage down the line.
Medicare Part B covers several major vaccines and treatments. Your flu shot will be covered under Medicare Part B. If your doctor or other healthcare provider accepts Medicare, you will likely pay nothing. Otherwise, you will be expected to cover part or all of the cost. With so many healthcare providers offering flu shots, it pays to call ahead to ask about their Medicare policies. Doing your due diligence could prevent you from receiving an unexpected bill.
Are flu shots covered by insurance if you are a Medicaid user? This is where matters can get confusing because Medicaid is only required to cover recommended vaccines for children and a limited number of vaccines for adults. Every state has its own rules regarding what Medicaid covers. Whether your flu shot is covered or not depends on where you live. Still, the majority of states offer coverage for the flu vaccine under Medicaid.
However, Medicaid differs from Medicare because the former is not required to cover the cost of the flu vaccination in full. Where you live and where you receive your shot determines whether you are responsible for a copayment. Contact your local agency to find out more.
What Can I Do if My Plan Doesn’t Cover My Flu Shot?
If the answer to the question, “is the flu shot covered by insurance?” is no, there are other avenues you can explore. One option is to contact your state’s health department. During the winter months, it is not uncommon for programs to offer free or discounted flu vaccines. However, this largely depends on which state you reside in and their commitment to public vaccination programs.
Alternatively, look up your nearest Federally funded health center. The majority of these locations provide affordable vaccines to those who cannot afford a flu shot and those who aren’t covered by health insurance.
The Flu, COVID-19, and Returning to Work
The winter of 2021 and heading into 2022 will almost certainly place significant strains upon the American healthcare system. Your best defense against complications from seasonal influenza is your annual flu shot. With many in the workforce returning to offices and resuming commutes, it’s never been more important to get the flu shot.
Insurance can be difficult to navigate sometimes. Eden Health can help answer your insurance coverage questions via the app. Employers who care about the health and wellness of their teams can benefit from an intelligent approach to telehealth. Make it easy for employees to manage their health with all the care they need, all in one place. Contact us to request a free demo of our collaborative care model that integrates insurance navigation, primary care, and mental health services.