Does My Insurance Cover Vaccines?
Staying up to date on your immunizations can reduce your risk of contracting serious illnesses. It's also one of the easiest ways you can stay healthy. Learn more about the vaccines covered by Blue Cross Blue Shield of Michigan and Blue Care Network.
There are more than a dozen vaccines available to you, depending on your situation. Here are the most common diseases you can get vaccinated against:
To get started, look at your Blue Cross ID card to see whether you have a PPO plan or an HMO plan.
Your Blue Cross Blue Shield of Michigan PPO plan covers vaccinations in most cases. However, if your employer purchased your plan before the Affordable Care Act was enacted, you may have a copay. To make sure you're covered:
Once you know whether you're covered, you can get vaccinated by:
To find an immunizing pharmacy in your area, follow these steps:
Blue Care Network HMO members can get free vaccinations two ways:
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.
According to the Centers for Disease Control and Prevention, during 2019 and 2020, the flu vaccine prevented 7 million influenza illnesses. It’s one of the most effective ways to prevent the flu and keep you and your family safe.
The CDC recommends that anyone over the age of 6 months should get a flu shot.
Some people have a higher risk for developing flu-related complications. If you have chronic conditions – such as asthma, heart disease, diabetes or chronic kidney disease – you should make getting the flu shot a high priority. The same is true for people who are 65 and older.
Early fall is the best time to get your flu shot. Getting vaccinated early is important, because the flu is highly contagious and spreads rapidly.
Getting the shot before the flu season is in full force gives the body a chance to protect itself. It takes about two weeks to be effective, so don't wait. Peak months for the flu season in Michigan are November through April.
If you have an HMO plan, your annual flu shot is free.
If you have a PPO plan, for most members, immunizations are covered at 100% in-network as part of the Affordable Care Act’s list of preventive benefits. If you get a vaccine from an out-of-network provider, you may pay out-of-pocket expenses up to the full cost of the vaccine.
Employer plans that aren’t subject to the Affordable Care Act’s requirements don’t have to cover the cost of vaccines. They may choose to cover the cost anyway.
Confirm your immunization benefits on your Blue Cross Blue Shield of Michigan or Blue Care Network policy by logging into your online account at bcbsm.com and searching for immunizations within your plan's benefits. If you still need help, call our customer service department using the number on the back of your member ID card.
If you’re required to pay for your flu shot, you may be reimbursed. For example, you may need to pay if you don’t have your Blue Cross or BCN member ID card on you when you get your flu shot. You can apply for reimbursement through your online account, or fill out one of these forms:
PPO members
Once you know whether you're covered, you can get vaccinated by:
If you don't have prescription coverage through us, your vaccine may still be covered. You can use your medical coverage and go to an immunizing pharmacy.
To find an immunizing pharmacy in your area:
HMO members
Blue Care Network HMO members can get free vaccinations two ways:
The Centers for Disease Control and Prevention has issued guidance stating that flu shots and COVID-19 vaccines can be given at the same time. Even though both vaccines can be given during the same visit, you should follow the recommended schedule for each vaccine.
While the COVID-19 public health emergency has ended, new variants of the virus continue to emerge, and updated vaccines are being released to prevent against severe cases.
The CDC recommends the 2024-25 updated COVID-19 vaccines for everyone ages 6 months and older. Children aged 5-11 years should get one dose of the updated 2024-25 Pfizer-BioNTech or Moderna COVID-19 vaccine to protect against serious illness from COVID-19. Anyone 11 years or older should get one dose of the updated 2024-25 Pfizer-BioNTech or Moderna COVID-19 vaccine, or one dose of the 2024–2025 Novavax vaccine unless they are receiving a COVID-19 vaccine for the very first time. If they have never received any COVID-19 vaccine and choose to get Novavax, they need 2 doses of 2024–2025 Novavax COVID-19 vaccine to be up to date.
People who are moderately or severely immunocompromised can receive additional doses. Children ages 6 months to 4 years need multiple doses of COVID-19 vaccines to be up to date, including at least one dose of the 2024-25 updated COVID-19 vaccine. Discuss any concerns with your health care provider.
For most people, COVID-19 vaccines are covered at 100% in-network as part of the Affordable Care Act’s list of preventive benefits. If you get a vaccine from an out-of-network provider, you may pay out-of-pocket expenses up to the full cost of the vaccine.
Employer plans that aren’t subject to the Affordable Care Act’s requirements don’t have to cover the cost of vaccines. They may choose to cover the cost anyway.
Confirm your immunization benefits on your Blue Cross Blue Shield of Michigan or Blue Care Network policy by logging into your online account at bcbsm.com and searching for immunizations within your plan's benefits.
If you get a diagnostic COVID-19 test at a health care provider, testing facility or lab whether or not you're experiencing COVID-19 symptoms, you’ll pay the standard copay and deductible under your medical benefit. This includes any out-of-network health care provider charges. Blue Cross doesn’t cover the costs of testing for employment, travel or participants in school and sports.
Confirm your diagnostic test benefits by logging into your online account and searching for diagnostic tests within your plan's benefits.
Over the counter tests, or OTC, kits are not covered for most people. You can purchase these test kits using your HSA plan (if you have one) or pay for them out of pocket.
Treatment by health care providers is subject to standard copays and deductibles. Follow the CDC for the latest guidance. Also learn more from the Michigan Department of Health and Human Services.
Confirm your benefits by logging into your online account.
Also access your benefits via the Blue Cross Blue Shield of Michigan app or by calling the number on the back of your card.
There are more than a dozen vaccines available to you, depending on your situation. Here are the most common diseases you can get vaccinated against:
To get started, look at your Blue Cross ID card to see whether you have a PPO plan or an HMO plan.
Your Blue Cross Blue Shield of Michigan PPO plan covers vaccinations in most cases. However, if your employer purchased your plan before the Affordable Care Act was enacted, you may have a copay. To make sure you're covered:
Once you know whether you're covered, you can get vaccinated by:
To find an immunizing pharmacy in your area, follow these steps:
Blue Care Network HMO members can get free vaccinations two ways:
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.
According to the Centers for Disease Control and Prevention, during 2019 and 2020, the flu vaccine prevented 7 million influenza illnesses. It’s one of the most effective ways to prevent the flu and keep you and your family safe.
The CDC recommends that anyone over the age of 6 months should get a flu shot.
Some people have a higher risk for developing flu-related complications. If you have chronic conditions – such as asthma, heart disease, diabetes or chronic kidney disease – you should make getting the flu shot a high priority. The same is true for people who are 65 and older.
Early fall is the best time to get your flu shot. Getting vaccinated early is important, because the flu is highly contagious and spreads rapidly.
Getting the shot before the flu season is in full force gives the body a chance to protect itself. It takes about two weeks to be effective, so don't wait. Peak months for the flu season in Michigan are November through April.
If you have an HMO plan, your annual flu shot is free.
If you have a PPO plan, for most members, immunizations are covered at 100% in-network as part of the Affordable Care Act’s list of preventive benefits. If you get a vaccine from an out-of-network provider, you may pay out-of-pocket expenses up to the full cost of the vaccine.
Employer plans that aren’t subject to the Affordable Care Act’s requirements don’t have to cover the cost of vaccines. They may choose to cover the cost anyway.
Confirm your immunization benefits on your Blue Cross Blue Shield of Michigan or Blue Care Network policy by logging into your online account at bcbsm.com and searching for immunizations within your plan's benefits. If you still need help, call our customer service department using the number on the back of your member ID card.
If you’re required to pay for your flu shot, you may be reimbursed. For example, you may need to pay if you don’t have your Blue Cross or BCN member ID card on you when you get your flu shot. You can apply for reimbursement through your online account, or fill out one of these forms:
PPO members
Once you know whether you're covered, you can get vaccinated by:
If you don't have prescription coverage through us, your vaccine may still be covered. You can use your medical coverage and go to an immunizing pharmacy.
To find an immunizing pharmacy in your area:
HMO members
Blue Care Network HMO members can get free vaccinations two ways:
The Centers for Disease Control and Prevention has issued guidance stating that flu shots and COVID-19 vaccines can be given at the same time. Even though both vaccines can be given during the same visit, you should follow the recommended schedule for each vaccine.
While the COVID-19 public health emergency has ended, new variants of the virus continue to emerge, and updated vaccines are being released to prevent against severe cases.
The CDC recommends the 2024-25 updated COVID-19 vaccines for everyone ages 6 months and older. Children aged 5-11 years should get one dose of the updated 2024-25 Pfizer-BioNTech or Moderna COVID-19 vaccine to protect against serious illness from COVID-19. Anyone 11 years or older should get one dose of the updated 2024-25 Pfizer-BioNTech or Moderna COVID-19 vaccine, or one dose of the 2024–2025 Novavax vaccine unless they are receiving a COVID-19 vaccine for the very first time. If they have never received any COVID-19 vaccine and choose to get Novavax, they need 2 doses of 2024–2025 Novavax COVID-19 vaccine to be up to date.
People who are moderately or severely immunocompromised can receive additional doses. Children ages 6 months to 4 years need multiple doses of COVID-19 vaccines to be up to date, including at least one dose of the 2024-25 updated COVID-19 vaccine. Discuss any concerns with your health care provider.
For most people, COVID-19 vaccines are covered at 100% in-network as part of the Affordable Care Act’s list of preventive benefits. If you get a vaccine from an out-of-network provider, you may pay out-of-pocket expenses up to the full cost of the vaccine.
Employer plans that aren’t subject to the Affordable Care Act’s requirements don’t have to cover the cost of vaccines. They may choose to cover the cost anyway.
Confirm your immunization benefits on your Blue Cross Blue Shield of Michigan or Blue Care Network policy by logging into your online account at bcbsm.com and searching for immunizations within your plan's benefits.
If you get a diagnostic COVID-19 test at a health care provider, testing facility or lab whether or not you're experiencing COVID-19 symptoms, you’ll pay the standard copay and deductible under your medical benefit. This includes any out-of-network health care provider charges. Blue Cross doesn’t cover the costs of testing for employment, travel or participants in school and sports.
Confirm your diagnostic test benefits by logging into your online account and searching for diagnostic tests within your plan's benefits.
Over the counter tests, or OTC, kits are not covered for most people. You can purchase these test kits using your HSA plan (if you have one) or pay for them out of pocket.
Treatment by health care providers is subject to standard copays and deductibles. Follow the CDC for the latest guidance. Also learn more from the Michigan Department of Health and Human Services.
Confirm your benefits by logging into your online account.
Also access your benefits via the Blue Cross Blue Shield of Michigan app or by calling the number on the back of your card.