Does Anthem Blue Cross Blue Shield Cover Vaccines?
- Anthem Blue Cross Blue Shield Medicare Advantage plans cover the same vaccines that Original Medicare covers, and some BCBS Medicare plans my cover additional vaccines that Original Medicare doesn’t. Learn more about BCBS Medicare and the preventive health care these plans may cover.
Vaccines are an integral part of keeping infectious diseases at bay, and many Anthem Blue Cross Blue Shield (BCBS) plan members might wonder if their plan will cover their shots. Anthem BCBS is part of the Anthem family of brands and the Blue group of affiliated companies.
Blue Cross Blue Shield health insurance and Blue Cross Blue Shield Medicare Advantage plans cover a range of vaccines. Below is a breakdown of what vaccines are covered by which BCBS plans.
When Do Blue Cross Blue Shield Medicare Plans Pay for Vaccines?
All Blue Cross Blue Shield Medicare Advantage plans must provide all of the same coverage as Medicare Part A and Part B, which together are often called Original Medicare. Medicare Advantage plans can also offer additional benefits Original Medicare doesn't cover, like dental, vision or prescription drug coverage.
Some vaccines are covered by Medicare Part B, which means Blue Cross Blue Shield Medicare Advantage plans are also required to cover them:
These shots are typically covered at no cost by a Blue Cross Blue Shield Medicare Advantage plan if you see a network provider, depending on the type of plan you have. Additional vaccines might be covered if a plan member is exposed to a particular danger, such as a tetanus shot after stepping on a rusted nail.
BCBS Medicare Advantage plans that include prescription drug coverage may cover additional vaccines.
Medicare Part D prescription drug plans cover medications including additional vaccines not covered by Medicare Part B. Part D plans cover all commercially available vaccines when medically necessary. Some of the vaccines that can be covered by a Blue Cross Blue Shield Part D plan (or Medicare Advantage plan with prescription drug coverage) include:
- Shingles
- MMR (measles, mumps, rubella)
- Hepatitis A and B
- Tuberculosis
- Meningococcal
- Tdap (Tetanus, diphtheria, pertussis)
Vaccines Covered by Group, Individual and Family Blue Cross Blue Shield Plans
Most health insurance plans are required by the Affordable Care Act (ACA) to cover a basic set of vaccines without charging a copayment or coinsurance when the shot is administered by a network provider. This requirement applies to individual and family plans as well as group-sponsored plans, with the only exceptions being plans that were grandfathered into the market prior to the 2010 passing of the ACA, also known as Obamacare.
The list of covered vaccines protected by the mandate include:
- Chickenpox
- Diphtheria
- Flu
- Hepatitis A and B
- Human Papillomavirus (HPV)
- Measles
- Meningococcal
- Mumps
- Whooping Cough (Pertussis)
- Pneumococcal
- Rubella
- Shingles
- Tetanus
While the above vaccines are required of most Marketplace health insurance plans, check your BCBC benefits summary or call the phone number on your plan ID card for confirmation of coverage. In addition to needing the vaccine to be administered by a network provider, certain other restrictions may apply to obtain full coverage of the vaccine.
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