Flu shots and your benefits
Most members can get their flu shot at no extra cost. This is because it’s part of the preventive care benefits required by the Affordable Care Act.
Some Blue Shield plans have low out-of-pocket costs for the flu shot. These include:
- Some grandfathered plans. Grandfathered plans may have a copay for flu shots. You may also need to visit a medical office, rather than a pharmacy, for your shot to be covered. You have a grandfathered plan if the plan name at the bottom of your card ends with a “G.” If you’ve had your plan since before March 23, 2010, you may have a grandfathered plan.
- Some self-funded or administrative services only (ASO) plans. Some of these plans come with a copay or coinsurance for immunizations. Not sure if you have an ASO plan? Check your member ID card. You have an ASO plan if it has “administrative services only” printed on the back bottom corner.
To view preventive care benefits, you can:
- Log in to your member dashboard and click “Benefits” under the “myblueshield” tab.
- Check your Evidence of Coverage (EOC) or Certificate of Insurance.
If you are still not sure if you have out-of-pocket costs for flu shots, please call the customer service number on your member ID card.
You can go to your doctor's office or, if your plan includes pharmacy benefits, to an in-network retail pharmacy. If your member ID card contains an “RxPCN” or “RxBIN” number, you have pharmacy benefits. Depending on your plan, other flu shot locations and services may be available to you. Visit our locations page to find a location near you.
- Some locations may not have access to all the types of flu vaccines.
- Some pharmacy locations may have age restrictions.
Contact the location before you go to find out if they have a specific kind of flu shot that you might need or if they have any age restrictions.
Check your Blue Shield of California or Blue Shield of California Promise Health Plan member ID card for a “RxPCN” or “RxBIN” number. If you see either of these, then your medical plan includes pharmacy benefits.
If this information is not on your medical member ID card, you may have pharmacy benefits through another company or pharmacy benefit manager (PBM). Please check with your employer or human resources department.
If you have this type of plan, please visit your doctor to get your flu shot. Your shot will be covered by your medical benefits, not your pharmacy benefits with Blue Shield.
Flu shots and your health
Make plans to get the flu shot in the early fall, before flu season begins. The CDC recommends that people get a flu shot by the end of October. It takes about two weeks after getting the shot for antibodies to develop in the body and provide protection against the flu.
Yes! According to the CDC, you can get a COVID-19 vaccine and other vaccines – like the flu shot – at the same visit. During the 2020-2021 flu season, COVID-19 vaccines were given alone. This was due to extreme caution and not because of any known safety concerns. The CDC now says it is safe to get them at the same time.
This update applies to COVID-19 booster shots, too. You are eligible for the booster shot eight months after receiving the second dose of the Pfizer or Moderna vaccine. These boosters should be available in late September. Boosters for the Johnson & Johnson vaccine are planned to be ready later in the fall. Learn more about COVID-19 booster shots.
Yes. Ask your doctor which one will work best for you. Options this season include:
- Standard dose flu shots
- High-dose vaccines for people 65 years and older
- Egg-free flu shots
- Nasal spray flu vaccine for ages 2 through 49
No. The CDC recommends the nasal flu vaccine for a select population and is not recommended for:
- Children under 2,
- Adults 50 and older,
- Pregnant women,
- Children between 2 and 17 years old who are taking aspirin or a salicylate-containing medication,
- People with weakened immune systems or who are in close contact with someone with a weakened immune system,
- Children 2 to 4 years old who have had asthma or wheezing in the past 12 months,
- People with ear (cochlear) implants, and
- People who have been treated recently with antiviral flu medication.
The CDC recommends that everyone age 6 months and older should get an annual flu shot, with rare exceptions.
Some people should talk with a doctor first before getting a flu shot. This includes:
- People who have a severe allergy to eggs
- People who have had a severe reaction to a previous flu shot
- People who have developed Guillain–Barré Syndrome (GBS) within six weeks of getting a flu shot
- People who have a moderate to severe illness or are feeling sick
Serious allergic reactions to the flu shot are very rare.
Some people have mild side effects afterwards. The most common are:
- Swelling at the injection site
Low-grade fever, headache and muscle aches also may occur, according to the CDC.
If these reactions occur, they mostly begin soon after vaccination and last one to two days. It is important to note, the most common reactions to the vaccine are much less severe than the symptoms caused by the actual flu illness.
Yes. Side effects from the nasal spray flu vaccine may include:
- Runny nose
- Muscle aches
- Sore throat and cough
If these side effects occur, they tend to begin soon after the spray is given and are mild and short-lived. It is important to note, the most common reactions are much less severe than the symptoms caused by actual flu illness.
Flu shot safety and efficacy
How well the flu vaccine works (or its ability to prevent flu illness) can vary from season to season. The vaccine’s effectiveness also can vary based on who is being vaccinated.
Two main factors impact how well the vaccine can protect a person from flu illness:
- The age and health of the person.
- The similarity or “match” between the flu viruses the vaccine is designed to protect against and the flu viruses spreading in the community.
The CDC does studies each year to see how well the flu vaccine protects against flu illness. While vaccine effectiveness can vary, recent studies show that flu vaccination reduces the risk of flu illness by between 40% and 60% among the overall population. This is during seasons when most of the flu viruses going around are well-matched to the flu vaccine.
Remember: Getting the flu shot may mean you get milder symptoms and have a shorter duration if you do get the flu.
Hundreds of millions of Americans have safely received flu shots over the past 50 years, according to the CDC.
Severe allergic reactions from a vaccine are very rare. They’re estimated at less than one in a million doses. If a reaction were to occur, it would likely be within a few minutes to a few hours after the vaccination.
As with any vaccine, look for any unusual symptoms. These can include a high fever, behavior changes, or signs of a severe allergic reaction.
Signs of a severe allergic reaction can include:
- Difficulty breathing
- Hoarseness or wheezing
- Swelling around the eyes or lips
- A fast heartbeat or dizziness
Life-threatening allergic reactions to the flu shot are very rare. These signs would most likely happen within a few minutes to a few hours after the vaccine is given.
Last Updated: 10/20/2021
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