Flu Vaccine

TRICARE covers flu vaccines based on the current flu season guidelines published by the Centers for Disease Control and Prevention (CDC) (www.cdc.gov/flu/). According to the CDC, all persons, including school-aged children, who want to reduce the risk of becoming ill with influenza (flu) or of transmitting the flu to others should be vaccinated.

It is strongly recommended the following people be vaccinated each year:

  • Children ages six months through 18 years, with continued focus on those at high risk for flu complications (ages six months through four years)
  • Adults age 50 years and older
  • All women who are pregnant during flu season
  • Health care workers involved in direct patient care
  • Caregivers and individuals who come in contact with children less than five years of age, and adults age 50 years and older, with particular emphasis on vaccinating those in contact with children younger than six months
  • Individuals who come in contact with persons at high risk for severe complications from the flu
  • People who live in nursing homes and other long-term care facilities
  • Adults and children who have chronic pulmonary (including asthma), cardiovascular (except hypertension), metabolic and renal disorders (including diabetes mellitus)
  • Adults and children who have weakened immune systems, including those caused by medications or by HIV
  • Adults and children who have any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders or other neuromuscular disorders) that can compromise respiratory function or increase the risk for aspiration, or who handle respiratory secretions
  • Children and adolescents aged six months to 18 years who are receiving long-term aspirin therapy and experience Reye's syndrome after a flu virus infection

Frequently Asked Questions

Q: What types of flu vaccines are covered?
A:
TRICARE covers the following two types of vaccines:

  • Flu shot – an inactivated vaccine containing a killed virus and given with a needle. This form of the vaccine may be used in all age groups.
  • Nasal-spray flu vaccine (FluMist) – a vaccine made with live, weakened flu viruses that do not cause the flu. This form of the vaccination is limited only to healthy people who are not pregnant aged two to 49 years.

Q: Where can a beneficiary get a flu vaccine?
A:
 Check with the local military treatment facility to determine if and when it is offering flu vaccines. TRICARE Prime, TRICARE Prime Remote and TRICARE Young Adult Prime beneficiaries can get the flu vaccine from their primary care manager (PCM) or any other TRICARE network provider without a referral. TRICARE Standard, TRICARE Reserve Select, TRICARE Retired Reserve, and TRICARE Young Adult Standard beneficiaries can get the flu vaccine from any TRICARE network or non-network provider.

Q: Are there any other TRICARE providers who can provide the flu vaccine?
A:
A convenient care clinic (CCC), urgent care clinic or retail network pharmacy that is TRICARE-authorized may also provide the flu vaccine.

Convenient care clinics are civilian health care clinics that can treat minor illnesses and may offer preventive services such as flu vaccines. They are usually located in high-traffic, retail-based locations that can include some retail pharmacies (e.g., CVS). Most CCCs are typically open seven days a week and appointments are usually not necessary.

You can locate CCCs and urgent care clinics through Health Net’s Network Provider Directory.

Q: Will TRICARE For Life (TFL) and Medicare pay for a flu vaccine every year?
A:
Medicare will pay for a flu vaccine once every flu season. In some cases this may mean twice in one year. For example, if the TFL beneficiary received the vaccine in January for one flu season, he or she could be inoculated again in October for the current flu season. The cost of the flu vaccine would be billed along with the doctor's visit. A TFL beneficiary cannot receive a flu vaccine from anywhere (e.g., a supermarket or pharmacy) and simply submit a claim to Medicare and TRICARE for reimbursement. It is important to find out in advance whether or not the entity providing the flu vaccine has made arrangements to submit claims for Medicare reimbursement. Medicare and TRICARE will only consider claims for services provided by a Medicare provider.

Q: When should the flu vaccine be administered?
A:
Beginning each September, the flu vaccine should be offered to people at high risk when they are seen by health care providers for routine care or as a result of hospitalization. See the ACIP Recommendations for Using Inactivated Influenza Vaccine. The best time to get vaccinated is October through November.

Q: How much does the flu vaccine cost?
A:
Flu vaccines are considered a preventive service benefit, therefore copayments do not apply.

Additional Information