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Third Party Payment for the Flu Vaccine Medicare will cover the vaccine again in 2010-11. When Medicare covers the vaccine they pay in full for the shot, with no co-payment or deductible. Medicaid/MDwise will pay for the pediatric dose for children age 6 months-35 months. If two shots are required, Medicaid/MDwise will pay for each individual dose. Pregnancy patients covered by Medicaid have variable coverage: Patients with Package B have no coverage for the flu vaccine, but it is covered for patients with Standard A coverage. Some managed care plans cover the vaccine, some do not. Some that do cover it apply the co-payment provision to it. Sometimes the flu vaccine is not a covered service, and, if not covered, the patient is responsible for payment. Many traditional indemnity insurance do not cover routine and preventive services, like the flu and pneumonia vaccines. If there are any questions regarding coverage, patients should check with their plan directly. Patients with traditional insurance who believe their insurance will not pay for their vaccine and self-pay patients without insurance are urged to pay for their vaccines at the time given, to keep paperwork costs low. If paid in advance (prior to receiving vaccine) they may receive the vaccine for the discounted price of $30.00 ($25.00 for each pediatric half-dose). If they prefer to be billed for the vaccine or if they prefer to wait to pay until after insurance has been filed, the cost will be $42.00 ($37.00 for each pediatric half-dose). Patients who wish to receive the discount should make their payment prior to receiving the shot. Payments may be made with cash, check, money order or credit card. Flu shot information for Partners in Health patients. Click here. What you should know about the flu and getting a flu shot. Click here. |