Member: I still need to get my vaccines scheduled and am wondering if it makes a difference whether I make an appointment at my clinic or elsewhere? —Chris, Rochester
Anita: Thanks for the question, Chris. This is a good topic. Because some vaccines are covered under Part B and some are covered under Part D, where you get your shots can affect what you pay.
For Part B, there is no cost for preventive vaccines from an in-network provider, such as your doctor’s clinic/office. If you go outside of your network, you will have a cost-share. The amount you pay depends on your plan. A shared cost also applies if you get Part B vaccines at an urgent care or emergency facility.
Part D vaccines should be administered by a pharmacist at your in-network pharmacy. If you get a Part D vaccine at a clinic, doctor’s office, or out-of-network pharmacy, you will have to pay 100 percent of that location’s charges up front. You could then submit a form to be reimbursed for your plan’s portion of the cost. How much you pay depends on what the clinic charges.
It’s important to note that when Blue Cross contracts with a provider, a maximum or “allowed” amount is established for what can be charged for a service. This helps to lower members’ out-of-pocket expenses. Because providers are not contracted under Part D, the maximum allowed amount does not apply for Part D vaccines.
