In the Donut Hole (also called the Coverage Gap) stage, you’ll pay more for your prescriptions. In 2016, the Donut Hole begins once you’ve spent $3,310 in one year. In the Post-Donut Hole (also called Catastrophic Coverage) stage. A flu shot is one of the best ways to prevent seasonal flu. Find answers to questions like why get a flu shot, who should get a flu shot, when and where to get one and more.
TRICARE covers an injectable flu vaccine or the nasal spray vaccine based on current flu season guidelines published by the Centers for Disease Control and Prevention (CDC) (www.cdc.gov/flu/). According to the CDC, everyone 6 months of age and older should get a flu vaccine every year. Currently, the nasal spray flu vaccine is approved for use in non-pregnant individuals, 2 years of age through 49 years of age. People with some medical conditions should not receive the nasal spray flu vaccine. Visit CDC’s Flu Vaccine page for more details.
The best time to get vaccinated is October through November.
- 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 Select, TRICARE Reserve Select, TRICARE Retired Reserve, and TRICARE Young Adult Select beneficiaries can get the flu vaccine from any TRICARE network or non-network provider.
- TRICARE For Life (TFL) beneficiaries can get the flu vaccine from a provider who has made arrangements to submit claims for Medicare reimbursement. Medicare and TRICARE will only consider claims for services provided by a Medicare provider.
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 (for example, 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 HNFS’ Network Provider Directory.
In addition to following general claims submission requirements, you must include the National Drug Code (NDC) number for the current flu season when submitting claims for the flu vaccine. (The NDC numbers expire after each season.) The NDC number can be located on CDC’s Vaccine Price List.
Flu vaccines are considered a preventive service benefit, therefore copayments do not apply.
Is There A Copay For Flu Shots
Copay For Flu Shot
- TRICARE’s Flu Resources page.
- CDC’s Influenza (Flu) page.
- Vaccines For Children (VFC) program information.
- Advisory Committee on Immunization Practice’s (ACIPs) Prevention and Control of Seasonal Influenza with Vaccines page.
- Military Health System’s Immunization Healthcare page.