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Does Insurance Cover Flu Shots – And Other Flu Season Answers

Flu season is nothing to sneeze at.

The Centers for Disease Control (CDC), estimate that last year’s flu (aka “influenza”) season (Oct. to Apr.) resulted in:

  • 39 to 56 million flu cases
  • 18 to 26 million doctor’s office visits for the flu
  • 410,000 to 740,000 flu-related hospitalizations
  • 24,000 to 62,000 flu deaths[0]

And there’s another complication to consider during the 2020-2021 flu season: the ongoing COVID-19 epidemic in the United States.

To learn more about COVID-19 and the flu and get answers to questions like “What’s the difference between the flu and COVID-19?” and “Can you get COVID-19 and the flu at the same time?” please check out the blog post, “What You Need to Know About COVID-19 and Flu Season.”

In the remainder of this post, we’ll cover just about everything to know about flu season, including:

  • Flu prevention
  • Where to get a flu shot
  • How to get a flu shot without health insurance
  • Who should get a flu shot

How to Reduce Your Risk of Contracting the Flu

Flu season occurs in the fall and winter in the United States, typically peaking between December and January.[1]

There are some preventative steps you may be able to take to reduce your risk of contracting the seasonal flu virus. In fact, you may have already implemented many of them this year due to COVID-19. Flu prevention includes:

  • Getting a flu vaccine (more on this later)
  • Avoiding contact with people who are sick
  • Covering coughs and sneezes
  • Washing hands often and avoiding touching your face
  • Cleaning and disinfecting surfaces and objects that may be contaminated[2]

More information and resources from the CDC to “fight the flu.”

Cold vs Flu – How to Tell the Difference

Cold and flu symptoms can be similar, though there is often a difference in the severity, onset, and/or duration.[3] See the table below for a comparison.

Cold vs Flu Symptoms[4]

Symptom Cold Flu
Symptom onset Gradual Abrupt
Fever Rare Usual (3-4 day duration)
Aches Slight Usual, severe
Chills Uncommon Fairly common
Fatigue, weakness Sometimes Usual
Chest discomfort, cough Mild to moderate, hacking cough Common, severe
Sneezing, Stuffy nose + sore throat Common Sometimes
Headache Rare Common

Learn the difference between the flu and COVID-19 symptoms.

If you experience severe symptoms of the seasonal flu, such as difficulty breathing, persistent chest pressure, dizziness, severe weakness or body aches, you should seek emergency medical care immediately.[5]

Who Should Get a Flu Shot?

The CDC recommends that everyone over the age of 6 months get a flu vaccine[6] beginning in September or October.[7]

People at a higher risk of developing severe symptoms or serious complications should make it a priority to obtain a flu shot. Those people can include:

  • Older adults
  • People with underlying medical conditions
  • Those that are pregnant
  • Young children[8]

View a detailed list of health and age factors that are known to increase a person’s risk of serious flu complications.

Where to Get a Flu Shot

The CDC is advising people to prepare for potential changes to how and where they obtain their flu vaccine this year due to COVID-19.[9] For example, workplaces and schools that normally run flu immunization clinics likely won’t be open this year.

Flu vaccines are typically available at pharmacy walk-in clinics, urgent care centers, and from your primary care physician. Use the VaccineFinder tool to find locations near you.

Does insurance cover flu shots?

ACA-qualifying health plans, whether that’s individual major medical coverage, an employer’s group health plan, Medicare, or Medicaid, are required to cover the flu and other vaccines without charging you a copay or coinsurance as long as you visit an in-network provider.[10]

If you’re not sure if you have qualifying coverage, contact your health insurance carrier to find out if the flu vaccine is covered.

Where can you get a low-cost or free flu shot without health insurance?

If you do not have health insurance or your insurance doesn’t cover vaccines, it may help to know that a seasonal flu shot is relatively affordable even without insurance at around $24 at a walk-in pharmacy clinic, or $32 at a physician’s office.[11]

And there are options for low-cost or free flu immunizations, especially for children.

Local federally funded health centers provide preventive services (including vaccinations) and may offer a sliding fee scale based on income. Locate a Health Center near you.

Under the Vaccines for Children Program (VFC) all recommended vaccines are provided at no cost for children 18 years old or younger who meet at least one of the following criteria, you:

  • Qualify for Medicaid
  • Are American Indian or Alaska Native
  • Have health insurance that doesn’t cover vaccinations (underinsured)
  • Have no health insurance coverage[12]

To locate a VFC provider near you, contact your state or local health department.

Health Insurance, Other Products to Help During Flu Season

Remember, ACA annual open enrollment begins November 1 for coverage effective January 1.[13]

Open enrollment is an opportunity to obtain a health insurance plan that covers vaccinations at no additional out-of-pocket cost, including influenza immunization.[14] These benefits apply to children[15] and adults.[16]

Plans also include benefits for a range of healthcare services that may be needed to help treat the flu, including doctor’s office visits, hospitalization, and emergency care.[17]

These benefits are especially important to ensure you receive timely care in the event you develop serious flu-related health complications as treatment can be expensive.

Average costs for flu-related treatment:

  • Flu testing and treatment at the doctor’s office: $147[18]
  • Flu testing and treatment at the walk-in clinic: $99[19]
  • Hospitalization for pneumonia:[20] $5,016 to $15,675[21]
  • Emergency room visit for a moderate problem: $538 to $1,679[22]

Learn how to get ready for ACA open enrollment.

ACA-Qualifying Health Plans for Comprehensive Coverage

ACA-qualifying plans cover essential health benefits, which include preventive care such as vaccinations. ACA policies are also guaranteed issue and cover pre existing conditions.

If you qualify, you may be able to obtain federal subsidies to help make premiums and/or out-of-pocket costs more affordable for plans purchased from the ACA Exchange.

Learn more about premium tax credits and cost-sharing reductions.

Low-income individuals, families, children, the elderly, people with disabilities, and pregnant people may qualify for free or low-cost ACA coverage through Medicaid.[23] See if you qualify for Medicaid.

Short Term Health Insurance for Coverage Gaps

A short term medical plan may be a good option if you have a gap in your comprehensive medical coverage and are unable to enroll in an ACA-qualifying policy until the annual open enrollment period (for coverage beginning Jan. 1).

Short term plans have more limitations and restrictions than ACA plans, for example, they don’t cover pre existing conditions, are not guaranteed issue, and typically don’t include coverage for preventive care, including immunizations.

However, they may provide benefits, subject to the plan’s deductible and coinsurance, for healthcare services commonly associated with unexpected illness such as the seasonal flu or pneumonia, which may require treatment in a hospital.

Compare short term medical plan benefits, costs, and premiums.

Get Short Term Medical Quotes

Telemedicine for Convenient Access

Virtual healthcare delivered via phone or an internet connection can be a more convenient way to get diagnosed and treated for seasonal flu should you become sick. The ability to obtain healthcare anytime from home (or anywhere, really) is even more critical as a large number of Americans continue to practice social distancing to avoid coming in contact with COVID-19.

And when patients with mild symptoms can get care from home it can also help overburdened urgent care centers.

In many cases, providers can diagnose, prescribe antiviral medication for pickup at your local pharmacy, and discuss other treatment steps via a telemedicine appointment, though in some cases, an in-person visit and flu test may be needed.[24]

Learn more about telemedicine to see if it might be a good option for you this flu season. Telemedicine is not health insurance.

Sign up for Telemedicine and Health + Wellness Discounts today. Everyone qualifies.

Get Telemedicine

Summary and Next Steps

The seasonal flu can be relatively mild or develop into a serious, life-threatening illness that requires emergency care or hospitalization, so it’s best to be prepared.

Know the symptoms to watch for and take steps to prevent infection. And particularly if you’re in a higher risk group, a seasonal flu shot may be one of those preventive steps to take.

Flu treatment can be expensive especially for those that develop complications like pneumonia, but there are health insurance options to help with costs.

An ACA-qualifying health plan, like individual major medical insurance, provides benefits for preventive care like flu shots, as well as a range of healthcare services like hospitalization, emergency care, and doctor’s office visits, making it a good option for getting the level of care you need this flu season.

If you’re unable to obtain an ACA policy now, obtaining a limited-benefit short term health plan if you qualify may help in the event you become sick and need treatment at a hospital or doctor’s office. You can get a short term medical quote to compare plan premiums and benefits.

And finally, COVID-19 is changing how we approach the 2020-2021 flu season.

To learn more about what healthcare providers and officials are expecting and what steps you may be able to take to be protected from COVID-19 this flu season, check out our blog post, “What You Need to Know About COVID-19 and Flu Season.

Have Questions? Speak to an Agent

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