The Good News About Flu Season

The summer is winding down and we are approaching flu season. Nevertheless, there is good news for patients and providers regarding the flu: The flu shot is now covered (with no corresponding patient responsibility) by more plans than ever before.

First, as a quick reminder, Centers for Disease Control and Prevention (CDC) makes a general recommendation that everyone who is 6 months or older obtain a flu shot. The CDC explains that a flu shot is particularly important for those who are more susceptible to developing serious health complications (and their caregivers) such as pregnant women, seniors, and those who have asthma, diabetes or chronic lung disease.

If your office provides flu shots, you’ll be pleased to know that more insurance plans are covering flu shots than ever before. Under the Affordable Care Act, many plans are required to provide full coverage for annual flu shots without any corresponding patient responsibility (i.e., no co-payment, deductible or co-insurance). However, the following two exceptions are important to keep in mind:

• The flu shot coverage requirement is limited to in-network patient encounters
• If a patient is covered under a “grandfathered plan” (i.e., a plan that existed on or before March 23, 2010), the Accountable Care Act coverage requirements do not apply to the plan

For a full list of preventive services that most plans must cover under the Accountable Care Act, click here.