Does Anthem cover vaccinations and immunizations?
Short answer
Insurance question
Yes — most Anthem commercial plans cover ACIP-recommended vaccines at $0 in-network, as required by the ACA. Medicare Advantage vaccine coverage follows Original Medicare rules, which may involve cost-sharing depending on the specific vaccine and benefit part.
This is an independent research summary, not official coverage information. Your plan is the final word.
Key facts
ACA requires most plans to cover all ACIP-recommended vaccines at $0 in-network.
Anthem Medicare Advantage members receive flu, COVID-19, and pneumococcal vaccines at $0 under Part B.
Out-of-network vaccine administration can result in cost-sharing even for ACA-required preventive vaccines.
KFF — Preventive Health Care Services for Adults Covered Under the ACA.
Here's the nuance
A one-liner rarely tells the whole story. This is the honest detail behind the short answer above.
Under the Affordable Care Act, most employer-sponsored and individual/family Anthem commercial plans are required to cover vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) at no cost to you — no copay, no coinsurance, and no deductible — when administered by an in-network provider. This includes widely-used vaccines like influenza (flu), COVID-19, Tdap (tetanus/diphtheria/pertussis), MMR, varicella, HPV, hepatitis A and B, pneumococcal, and shingles (Shingrix), among others.
If you go out of network for a vaccine, cost-sharing typically applies even for preventive vaccines. Some Anthem HMO plans may require that the vaccine be administered in a specific network setting (primary care office vs. pharmacy). If you get a vaccine at a pharmacy, confirm the pharmacy is in-network for your Anthem plan to avoid unexpected charges.
For Anthem Medicare Advantage members, the rules differ by vaccine. Most Part B vaccines (flu, COVID-19, pneumococcal, hepatitis B for high-risk) are covered at $0. Shingles and other vaccines covered under Part D may have cost-sharing depending on your plan's drug benefit design. Always check your plan's Evidence of Coverage or call the number on your Anthem member ID card to confirm what's covered and under which benefit.
State-specific Anthem plans (Anthem Blue Cross, Anthem Blue Cross Blue Shield, etc.) may have additional covered vaccines or wellness incentives. Check your Summary of Benefits and Coverage or the Anthem member portal for the complete preventive care schedule applicable to your specific plan.
The key points
The handful of things that decide the answer — skim these if you only read one section.
ACA mandates $0 preventive vaccines in-network
For most Anthem commercial plans, ACIP-recommended vaccines must be covered with no cost-sharing when received from an in-network provider — even before your deductible is met.
Network matters — going out of network triggers cost-sharing
Getting vaccinated at an out-of-network clinic or pharmacy can result in copays or coinsurance even for required preventive vaccines. Always confirm the provider is in Anthem's network first.
Medicare Advantage vaccine rules are different
Anthem MA members typically get flu, COVID-19, and pneumococcal vaccines at $0 under Part B. Other vaccines like shingles fall under the Part D drug benefit and may involve cost-sharing depending on your plan's formulary tier.
Travel vaccines are generally not covered
Vaccines required specifically for international travel (e.g., yellow fever, typhoid, Japanese encephalitis) are usually not covered under standard Anthem preventive benefits. Check your plan documents for any travel health add-ons.
Verify with your plan before getting vaccinated
Call the member services number on your Anthem ID card or log into the Anthem member portal to confirm which vaccines are covered, what your network requirements are, and whether any prior authorization is needed.
Confirm before you rely on this
Coverage varies by plan — this is not official
Coverage rules, benefit tiers, and medical-necessity criteria change often and differ by plan type, state, employer, and your specific policy. This page is a general, independent research summary — it is not official information from any insurer, not a benefits determination, and not financial or insurance advice.
Verify your exact coverage by calling the member number on your insurance card or checking your plan documents before you rely on any answer here.
Frequently Asked Questions
Yes — most Anthem commercial plans cover the annual influenza vaccine at $0 in-network under ACA preventive care requirements. This applies once per flu season. Getting your flu shot at an in-network pharmacy or your primary care doctor's office is the easiest way to ensure no cost. Medicare Advantage members typically get the flu vaccine at $0 under Part B as well. Check your Anthem plan documents for details.
It depends on your plan type. For most Anthem commercial plans, Shingrix is covered at $0 as a preventive vaccine under ACA rules. For Medicare Advantage members, Shingrix typically falls under the Part D drug benefit rather than Part B, so cost-sharing may apply depending on your plan's drug formulary tier. Log in to the Anthem member portal or call member services to check your specific coverage before getting the vaccine.
Vaccines administered at a pharmacy are generally covered at $0 under Anthem commercial plans if the pharmacy is in-network for your plan. Some Anthem HMO plans may restrict in-network pharmacy coverage or require vaccines to be given at a contracted clinical setting. Confirm the pharmacy participates in your Anthem network before visiting, as out-of-network pharmacies can result in unexpected cost-sharing even for preventive vaccines.
For most preventive vaccines under Anthem commercial plans, no referral is required. Vaccines recommended by ACIP and covered under ACA preventive care rules do not require prior authorization when received in-network. However, Anthem HMO members may need to receive vaccines through their primary care provider or a specific network pharmacy. Check your plan's Summary of Benefits or call member services to be sure.
Anthem commercial plans generally cover all ACIP-recommended vaccines, which include: influenza (annual), COVID-19 (primary series and boosters), Tdap and Td, MMR, varicella, HPV (for eligible ages), hepatitis A and B, pneumococcal (PCV15, PCV20, PPSV23), shingles (Shingrix), meningococcal, and RSV (for eligible groups). The exact list and applicable ages are updated as ACIP recommendations change. Always verify the current preventive schedule with your specific Anthem plan.
Reviewed by
Curex Editorial TeamReviewed for accuracy
Last reviewed July 2026
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Read moreYour plan has the final say
The surest way to know what's covered is to ask the source. Call the member number on your insurance card or sign in to your plan portal, and have the service or medication name ready — a quick call beats guessing.
This page is independent research, not a benefits determination — your insurer's answer is the one that counts.
This content is for general informational purposes only. It is not official coverage information, a benefits determination, or financial or insurance advice. Coverage rules, benefit tiers, and medical-necessity criteria change often and vary by plan, state, and effective date — always verify your specific benefits directly with your insurer before making any decision.
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