Understanding bcbs vaccine coverage and Reimbursement

So you're looking to understand BCBS vaccine coverage and reimbursement? First, it's essential to note that BCBS (Blue Cross Blue Shield) covers COVID-19 vaccines for most members.

BCBS covers COVID-19 vaccines for most members, but there may be some specific requirements or restrictions. Some plans may require a copayment or coinsurance, while others may have a maximum out-of-pocket limit for vaccine costs.

As of now, BCBS doesn't require prior authorization for COVID-19 vaccines, but it's always a good idea to check with your provider or plan administrator to confirm.

Blue Cross Blue Shield Medicare Advantage plans cover certain vaccines at no cost when you see a network provider, including flu, COVID-19, pneumococcal, and hepatitis B for those deemed high risk.

Some vaccines are covered by Medicare Part B, which also requires Blue Cross Blue Shield Medicare Advantage plans to cover them. These vaccines include flu, COVID-19, pneumococcal, and hepatitis B for those deemed high risk.

BCBS Medicare Advantage plans that include prescription drug coverage may cover additional vaccines. These include shingles, MMR, hepatitis A and B, tuberculosis, meningococcal, and Tdap.

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.

Most health insurance plans, including individual and family plans, are required by the Affordable Care Act to cover a basic set of vaccines without charging a copayment or coinsurance. This list includes chickenpox, diphtheria, flu, hepatitis A and B, human papillomavirus, measles, meningococcal, mumps, whooping cough, pneumococcal, rubella, shingles, and tetanus.

Here's a list of vaccines covered by most health insurance plans:

If you receive the COVID-19 vaccine at an in-network provider, it will be covered at 100% by Blue Cross NC and ASO groups as part of our preventive care services.

If you have a Blue Cross Blue Shield plan, you're in luck - most vaccines are covered without charging a copayment or coinsurance when administered by a network provider.

The Affordable Care Act requires most health insurance plans to cover a basic set of vaccines, including chickenpox, diphtheria, flu, hepatitis A and B, human papillomavirus (HPV), measles, meningococcal, mumps, whooping cough (pertussis), pneumococcal, rubella, shingles, and tetanus.

Check your BCBS benefits summary or call the phone number on your plan ID card for confirmation of coverage, as certain restrictions may apply to obtain full coverage of the vaccine.

The list of covered vaccines is quite extensive, and you can find it in the article section:

COVID-19 vaccines are also covered by Blue Cross NC, but the details are a bit different.

Effective May 12, 2023, Blue Cross NC and ASO groups will cover both the cost of the vaccine and vaccine administration at 100% when members receive the COVID-19 vaccine at an in-network provider as part of their preventive care services.

If you receive the COVID-19 vaccine at an out-of-network provider, you may be responsible for the cost of the vaccine and/or vaccine administration based on your individual preventative care benefits.

The federal government has invested in a large supply of COVID-19 vaccines and will continue to cover the cost of the COVID-19 vaccine until that supply is exhausted.

If you're looking to get vaccinated, you can find a location near you by using the vaccine location tool provided by NCDHHS for North Carolina residents.

To locate a vaccine or booster location outside of North Carolina, you can search vaccines.gov, text your ZIP Code to 438829, or call 800-232-0233.

You can also use FEP's vaccine network to locate a participating retail pharmacy if you're a Federal Employee Plan member.

The list of covered vaccines protected by the mandate includes:

Most health insurance plans are required to cover these vaccines without charging a copayment or coinsurance when the shot is administered by a network provider.

COVID-19 treatments are covered based on each individual's insurance plan, and members may be responsible for a portion of their treatment costs to include copayments, coinsurance and deductible amounts.

Blue Cross NC Medicare Advantage members will be responsible for cost sharing when receiving treatment at an out-of-network facility, as specified under the plan benefit, beginning on June 10, 2023.

Members may need to pay a portion of their treatment costs, but the exact amount will depend on their insurance plan.

Blue Cross NC Medicare Advantage members will continue to be covered under the Part B preventive vaccine benefit when receiving monoclonal antibodies until the end of the calendar year that the EUA declaration ends.