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AM I COVERED?Insurance plans covering 96% of commercially insured members cover SHINGRIX. WHERE SHOULD I GET SHINGRIX? Pharmacy HOW MUCH WILL SHINGRIX COST? 90% of privately insured patients 50 years and older pay no or limited out-of-pocket costs with the average cost being less than $5 per dose. WHAT ELSE SHOULD I KNOW? The Affordable Care Act (ACA) requires all Health Insurance Marketplace plans and most other private health insurance plans to cover all ACIP-recommended vaccines, including SHINGRIX, with no cost sharing (deductibles, copayments, or coinsurance) if administered in-network. ACIP=Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. AM I COVERED?SHINGRIX is covered under Medicare Part D. WHERE SHOULD I GET SHINGRIX? Pharmacy HOW MUCH WILL SHINGRIX COST? Most patients pay an out-of-pocket cost less than $50 per dose. WHAT ELSE SHOULD I KNOW? More than 95% of Medicare Part D enrollees receive SHINGRIX at a pharmacy. Most doctors’ offices cannot bill for vaccinations for Part D enrollees. If you’d like to receive SHINGRIX at your doctor’s office, ask them if they're able to bill for Part D before vaccination. AM I COVERED? Coverage varies state by state. Medicaid covers SHINGRIX for patients 50 years and older in two-thirds of states (those that expanded Medicaid under the Affordable Care Act). WHERE SHOULD I GET SHINGRIX? Pharmacy HOW MUCH WILL SHINGRIX COST? If your state expanded Medicaid, SHINGRIX is likely covered by your plan with no cost-sharing if administered in-network with the average cost being less than $5 per dose. WHAT ELSE SHOULD I KNOW? To date, 38 states and the District of Columbia have expanded their Medicaid program and are likely to cover SHINGRIX. The remaining 12 states are less likely to cover SHINGRIX. FIND OUT IF YOUR STATE EXPANDED MEDICAID WHERE SHOULD I GET SHINGRIX? Pharmacy HOW MUCH WILL SHINGRIX COST? If you’re paying out of pocket for SHINGRIX, individual costs may vary. Contact your healthcare provider to learn more about your expected cost. WHAT ELSE SHOULD I KNOW? GSK offers programs to help patients without insurance access with the cost of their medications, including SHINGRIX. To learn more, visit GSKForYou.com
COVID-19
At-Home Tests Reimbursement (2/18/22): For more information on the new policy and coverage details, visit our at-home COVID-19 test coverage page. Updated Booster Shots (10/26/22): The FDA has authorized, and the CDC recommends, the updated/Bivalent COVID-19 booster shot for children 5 and older. To learn more,
visit CDC.gov. Blue Cross members are covered for the COVID-19 vaccination. We’ll cover any costs related to
administration of vaccines, with no member cost share. Medicare Advantage and Medex®' members are covered with no cost share when vaccines are administered by any provider who accepts Medicare. All U.S. residents 5 and older are now eligible for COVID-19 vaccination. Those who live, work, or study in Massachusetts can
register for a COVID-19 vaccine appointment at retail pharmacies, health care providers, or other community locations by visiting vaxfinder.mass.gov. Walk up appointments are also available at many locations. People ages 5-17 can only get the Pfizer vaccine. For our out-of-state members, please visit your state's
health department website for local distribution plans. For more information, see our frequently asked questions. Yes, the vaccines are safe. The U.S. vaccine safety system works to make sure all vaccines are as safe and effective as possible. Learn more about how government health experts are ensuring COVID-19 vaccines are safe and effective by visiting the Centers for Disease Control. Visit the
CDC Yes, the COVID-19 Vaccine is recommended
for those who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future. Pregnant and recently pregnant people are at an increased risk for severe illness from COVID-19 when compared with non-pregnant people. If you have questions, talk to your doctor and visit the
CDC website for more information. All COVID-19 vaccines continue to be highly effective in reducing risk of severe disease, hospitalization, and death. The CDC recommends a booster shot for individuals 12 and older who have been fully vaccinated. With the Pfizer vaccine, a booster shot should be administered five months or more after the original vaccine series. With the Moderna vaccine, a
booster shot should be administered six months or more after the original vaccine series. Adolescents 12-17 years old are only eligible for the Pfizer booster. For adults who received the Johnson & Johnson vaccine, CDC recommends a booster shot be administered two months after the original vaccination. We'll cover booster shots with no out-of-pocket cost to eligible members.
Find out if you're eligible. Those who are eligible can register to receive a COVID-19 booster shot at retail pharmacies, health care providers, or other community locations by
visiting vaxfinder.mass.gov or calling 211. The CDC recommends that anyone with any signs or symptoms of COVID-19 get tested, regardless of vaccination status or prior infection.
If you get tested because you have symptoms or were potentially exposed to the virus, you should stay away from others pending test results and follow the advice of your healthcare provider or a public health professional. Visit
Mass.gov for more information. Yes, it is. The Pfizer vaccine has undergone rigorous clinical testing on adults and children, along with comprehensive review by the Food & Drug Administration and an independent Centers for Disease Control and Prevention advisory panel. The vaccine’s safety was studied in more than 3,000 children ages 5–11, who received the vaccine and experienced no serious side effects (the most
common was a sore arm). Get more facts from Mass.gov. All U.S. residents age 5 and older are now eligible for the COVID-19 vaccine. You can make an
appointment for children ages 5-11 at retail pharmacies, health care providers, or other community locations by visiting vaxfinder.mass.gov. Walk-up appointments are also available at many locations. For our out-of-state members, please visit your state's health department website for local distribution plans. Yes, it’s safe to get both vaccines at the same time. Read more from the CDC. Two doses, three weeks apart. Children ages 5–11 receive an age-appropriate dose that is one-third of the adult dose of Pfizer-BioNTech COVID-19 vaccine. Smaller needles, designed specifically for children, are also used for children ages 5 –11. For more information on the new policy and coverage details, visit our at-home Covid-19 test coverage page. Additionally,
we will continue to cover FDA-authorized COVID-19 diagnostic tests, such as PCR tests, with no cost share to members when ordered or administered by a health care provider following an individualized clinical assessment. This applies to our commercial and Medicare members. For any questions or concerns related to COVID-19, call our dedicated member COVID-19
Helpline. CALL: 1-888-372-1970 Here’s how to access your medical,
mental health, and dental care with as few barriers as possible. We're
covering the full cost of FDA-approved COVID-19 diagnostic testing with no cost sharing, as long as the test is ordered by a health care provider and meets CDC guidelines. Medicare members, please refer to Medicare coverage details below. We’re removing member cost share (copayments, co-insurance, and deductibles) for COVID-19-related inpatient care at both in- and out-of-network acute care facilities for our fully insured members. Until further notice, simply arrange for your care as always, and your claims will be processed to reflect this coverage. To access vital information and updates sign in to MyBlue or create an account. Note: Self-insured accounts make their own plan cost-share decisions and may have chosen not to waive this inpatient cost share. If you have any questions about your plan, call Member Service at the number on your ID card. We’ve enhanced routine care benefits so members can now get fully covered, routine dental checkups twice a year, without having to wait six months between them. Get the Toothpic®' Teledentistry App Here’s how we’re enhancing Medicare benefits. Simply arrange for your care as usual, and your claims will be processed to reflect this coverage. We’re removing copayments, co-insurance, or deductibles for all medically necessary COVID-19-related care received at: Any medically necessary treatment for COVID-19 is covered under a member's health plan within the United
States or internationally. We’re also removing member cost share (copayments, co-insurance, and deductibles) for COVID-19-related inpatient care at both in- and out-of-network acute care facilities for our fully insured members. Simply arrange for your care as always, and your claims will be processed to reflect these waived costs. Note: Self-insured accounts design/customize their plans and benefits and may require inpatient cost share. If you have any questions about
your plan, call Member Service at the number on your ID card. We're waiving all member cost share (copayments, co-insurance, or deductibles) for members who receive care via, phone, video, or telehealth in place of an office visit, for COVID-19 services, when received from an in-network provider. All members can talk to a licensed doctor or
provider from the comfort and safety of home, limiting the potential exposure to, and spread of, the virus. Call your provider to request remote visits by phone or video. Members with our telehealth benefit are encouraged to use our Well Connection platform. For Medicare HMO Blue and Medicare PPO Blue members: *Benefits may vary by plan We’ve removed any administrative barriers, such as prior authorizations and referrals, for medically appropriate care for COVID-19. We still require providers to notify us when a member is admitted to the hospital. Simply make arrangements for care as usual, now with
faster access. The CARES Act passed by Congress includes a provision that allows members to use financial account funds to pay for over-the-counter (OTC) medications, without a prescription, as well as menstrual care products. Claims must be for purchases made on or after January 1, 2020. Merchants and financial account administrators are
working to allow for payment for these products at the point-of-sale. In the meantime, members can manually submit claims to their financial account administrator for reimbursement. Important note: Plans vary by employer, and these changes don't necessarily change the benefits available under an employer's plan. Members should review plan documents carefully or consult their employers for information about their companies’ benefits. If you're eligible, coverage for yourself and your dependents can be purchased directly from Blue Cross or any other health insurer, or through the Massachusetts Health Connector. If you're interested in a Blue Cross plan, or to find out if you're eligible, please visit getbluema.com or call 1-800-422-3545. If you have coverage through Dental Blue®, and until further notice, you can receive care from your dentist via telephone or video if your
dentist offers virtual services. Services provided by non-participating dentists could be subject to balance billing. Our members are covered for emergency medical care while traveling internationally. If someone were to be hospitalized while traveling, costs would be covered according to the terms of your plan. You can purchase additional health
insurance designed for travelers from any number of companies. Blue Cross offers health insurance for travelers that provides extended coverage, called GeoBlue®. You can learn more at geobluetravelinsurance.com/bcbsma, or by calling 1-855-481-6647. Donec auctor condimentum felis a rhoncus. Sed massa nulla, placerat sit amet magna vel, tempus vehicula orci. Nam nec urna porta, tincidunt turpis et, semper nisl. Here are additional resources everyone can use. This easy guide will help you make decisions and seek medical care, if necessary. Check my symptoms Get the latest updates on the virus and what you can do to minimize exposure and spread. Get info See how Massachusetts is coordinating response, and how we can all do our part. Learn more Your 411 on everything COVID-19, from trending topics to timely tips. Learn more Learn more |
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