Flu Shot Information for TRICARE Beneficiaries
TRICARE covers influenza vaccinations for TRICARE beneficiaries. As the flu season begins, here are some important points regarding flu shots for TRICARE beneficiaries in the West Region.
Who Should Be Vaccinated?
- All children age 6-23 months
- Adults age 50 and older
- Nursing home residents and other individuals in long-term care facilities housing anyone of any age with chronic medical conditions
- Adults and children with chronic disorders of the lungs or heart such as asthma, COPD (Chronic Obstructive Pulmonary Disease), Emphysema, Chronic Bronchitis, or Cystic Fibrosis
- People who have a suppressed immune system
- Children and teens on long-term aspirin therapy
- Healthcare providers
Who Should Not Be Vaccinated?
The flu vaccine has been grown on egg protein; therefore the flu vaccine is not recommended for people who have a history of severe chicken egg allergy. If the patient has been able to eat eggs, he/she may be able to receive the flu vaccine.
Others who should not be vaccinated include:
- People who have had a severe reaction to an influenza vaccine in the past.
- People who developed Guillain-Barre syndrome (GBS) within 6 weeks of getting an influenza vaccine previously.
- Children less than 6 months of age (influenza vaccine is not approved for use in this age group).
- People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen.
When to Vaccinate?
Each year, the flu vaccine is developed with three strains of influenza virus. These strains have been identified as the cause for the illness in the upcoming year. The best time to vaccinate patients is October through November, but vaccinating in December or even later can still be beneficial because most influenza activity occurs in January or later in most years. Though it varies, flu season can last as late as May.
What about the Pneumococcal Vaccine?
The Pneumococcal vaccine can lessen the chance of Pneumococcal pneumonia. Although Pneumococcal pneumonia may occur as a major complication of the flu, the vaccine is not a substitute for the flu vaccine. The Pneumococcal vaccine helps to protect someone from strains of bacterial pneumonia. It is generally recommended for many of the same high-risk people for whom influenza vaccine is recommended. People with emphysema, COPD, congestive heart failure, cirrhosis, renal failure, diabetes or Hodgkin’s disease should be given the Pneumococcal l vaccine. In addition, people over age 65, and those with asymptomatic HIV infection should receive the vaccine. The Pneumococcal vaccine is given every 5-7 years. It is safe to receive both the influenza and Pneumococcal vaccines at the same time.
There is no flu vaccine shortage this year for military treatment facilities (MTFs). Beneficiaries may obtain their flu shot at the MTF.
TRICARE Coverage
Below is a chart comparing influenza vaccination coverage for TRICARE Prime, Standard, Extra and Prime Remote beneficiaries.
| TRICARE Program | Influenza vaccination coverage | Vaccine location | Deductibles or cost-shares |
| Prime | Yes | Primary care manager (PCM) (Network or MTF) | None, unless using a non-network provider without a referral |
| TRICARE Prime Remote | Yes | Network or non-network provider | None |
| Standard/Extra | Yes | Network or non-network provider | Yes, the usual deductibles and cost-shares apply |
Here are some additional important points regarding influenza vaccination coverage:
- If a TRICARE Prime beneficiary goes to a retail outlet, such as a drug store or a grocery store for his or her vaccine and the vaccine is provided by a TRICARE-authorized provider such as a nurse, the shot will be paid under the point-of-service (POS) benefit. County health services employees are not TRICARE-authorized providers and therefore, the claim will not be paid.
- Except for beneficiaries over 50 years old, flu mist is a TRICARE covered benefit when administered by a network provider or by a TRICARE Prime beneficiary’s PCM.
For further information, refer to www.tricare.mil, www.triwest.com or contact TriWest at 1-888-TRIWEST (888-874-9378).