Will health insurance cover my flu shot?

Tamara E. Holmes

If you've ever experienced the nausea, body aches or chills associated with the flu, that's probably an experience you don't want to repeat. Luckily, there's a good chance you won't have to if you take the time to get a flu shot -- a preventive measure that is likely 100 percent covered by your health insurance plan.

flu shotWhat is the flu?

The flu, short for influenza, is a respiratory illness caused by influenza viruses, which can infect your nose, throat and lungs. The flu is contagious, infecting between 5 percent and 20 percent of the American population each year, according to the Centers for Disease Control and Prevention. It's typically transmitted by droplets emitted when an infected person coughs or sneezes. If you inhale those droplets, you may become sick. Likewise, if the droplets land on an object that you touch, the virus can then be inhaled or ingested if you put your hands near your nose or mouth. Flu season in the United States typically lasts from October to May, and peaks in January or February.

Some cases of the flu can be severe. "A lot of times, we think of the flu as a mild disease, but people die from the flu and flu-related complications," says Dr. Ajani Nimmagadda, a senior medical director at Cigna. In the U.S., on average, more than 200,000 people must be hospitalized each year because of flu-related complications. The number of flu-related deaths in the U.S. in a given year has ranged from 3,000 to about 49,000.

Other flu symptoms include fever, cough, sore throat, fatigue and a runny or stuffy nose. Complications of the flu include pneumonia, sinus infections and dehydration. The flu can also worsen some chronic medical conditions, such as asthma, diabetes and congestive heart failure.

Certain people are more at risk of suffering complications from the flu, including:

  • Children younger than 5, particularly those under 2.
  • Adults 65 and older.
  • Pregnant women.
  • People with a weakened immune system or underlying conditions such as chronic lung disease, blood disorders and heart disease.

How to prevent the flu

The best way to prevent getting the flu is to get a flu vaccine, says Nicholas Kelley, research associate for the Center for Infectious Disease Research and Policy at the University of Minnesota.

There are two types:

  • The flu shot, which is an injection of influenza viruses that have already been inactivated or killed.
  • The nasal spray vaccine, which is a spray made of weakened, live influenza viruses.

Neither the flu shot nor the nasal spray vaccine will cause you to get the flu, though there could be minor side effects such as soreness or swelling where the shot was given and a low-grade fever. The CDC estimates that for the general population the vaccine can reduce the risk of getting the flu by about 60 percent.

Even if you've gotten a flu shot in the past, that won't protect you from this year's flu since the vaccine changes each year based on the strains of the flu that are most lost likely to circulate.

Researchers predict which strains will be prevalent by looking at which strains are circulating in other parts of the world. "In the Southern Hemisphere, their flu season happens during our summer," Kelley says. Researchers expect that the same strains will impact Americans in the fall, so manufacturers produce the vaccine that will prevent those strains.

Who should get the flu shot?

While the CDC recommends that everyone over the age of 6 months get the flu vaccine, it is particularly important that those who have a high risk of flu-related complications and the caretakers of such individuals get vaccinated, Nimmagadda says. You should get it as soon as it's available, typically in October, though it's not too late to get the shot later in the flu season.

You shouldn't get the flu vaccine if you've had a severe allergic reaction to it in the past, if you have a severe allergy to chicken eggs or if you've ever had Guillain-Barre Syndrome, an immune system disorder that can lead to paralysis. Children younger than 6 months also should not get the flu vaccine.

You can get the flu vaccine in such places as your doctor's office, urgent care centers and school health centers. In some states, pharmacists are licensed to administer the flu shot, so you might even be able to get it in your local grocery store pharmacy. If you've ever had side effects or an allergic reaction to the flu shot in the past, Nimmagadda advises that you get it from your doctor's office.

Since the flu shot is considered a preventive care benefit, most health insurance plans, including plans in the Obamacare health insurance exchanges, will cover it at no cost to the patient.

If you can't afford insurance, you may be able to qualify for Medicaid, or get flu shots for children through the Vaccines for Children Program, which provides free vaccinations for people 18 and younger who are uninsured or underinsured.

Getting the flu vaccine may take 30 minutes out of your day, but it can save you from being homebound for a week. "If you have the opportunity to prevent yourself from being sick on the couch and feeling miserable, I don't see why you wouldn't do it," Kelley says.