Does Blue Cross Blue Shield Cover Vaccines?
- 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.
Blue Cross Blue Shield health insurance and Blue Cross Blue Shield Medicare Advantage plans do indeed cover a wide 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.” Most Medicare Advantage plans also offer extra benefits like dental, vision, prescription drug coverage and more, all of which are not covered by Original Medicare.
Four vaccines are covered by Medicare Part B, which means Blue Cross Blue Shield Medicare Advantage plans are also required to cover them:
- Flu
- COVID-19 (coronavirus)
- Pneumococcal
- Hepatitis B (those deemed to be high risk)
These shots are covered at no cost to the delivered at a Blue Cross Blue Shield network provider. Additional vaccines are typically 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, except those covered by Medicare Part B, when they are reasonable and necessary to prevent illness.” 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.
Find Blue Cross Blue Shield Medicare Plans That Cover Vaccines and More
To learn more about the BCBS Medicare plan options available in your area, contact a licensed insurance agent. Remember, most Medicare Advantage and Medicare Part D plans will typically cover the same set of vaccines, so there may be additional benefits or costs to consider when choosing between plans.
