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Center for Medicare and Medicaid Services info on H1N1

Posted Oct 19 2009 10:02pm

Medicaid and the Children’s Health Insurance Program (CHIP) Coverage of the 2009 H1N1Flu Vaccine and Treatment

The 2009 H1N1 flu (sometimes referred to as “swine flu”) is caused by a new strain of influenza virus. It is causing illness in people. The virus spreads from person-to-person, probably in much the same way that regular seasonal flu viruses spread.The symptoms of the 2009 H1N1 flu are similar to the symptoms of regular seasonal flu.These symptoms include fever, cough, sore throat, runny or stuffy nose, body aches,headache, chills, and fatigue. A significant number of people who have been infected with the 2009 H1N1 flu virus also have reported diarrhea and vomiting.

If you have flu-like symptoms, call your doctor’s office right away.

 Is there a vaccine for the 2009 H1N1 flu, like there is for the seasonal flu?Yes. The initial doses of the 2009 H1N1 flu vaccine are currently available for those at highest risk for infection. Additional doses are scheduled for shipment each week.Who should get the 2009 H1N1 flu vaccine?


There are some groups of people who have a higher risk of getting the 2009 H1N1 flu than others. Therefore, the Centers for Disease Control and Prevention (CDC) has recommended that the following groups get their vaccine as soon as it becomes available in their area:

•Pregnant women•People who live with or care for children younger than 6 months of age•Healthcare and emergency medical services personnel•Persons between the ages of 6 months through 24 years•People ages 25 through 64 years who are at higher risk because of chronic health disorders or weakened immune systems

If you aren’t in one of the groups listed above, talk with your doctor about when to get the vaccine.

Note: If you are sick and need to be in close contact with someone who has a higher risk of getting the 2009 H1N1 flu, consider wearing a surgical mask or cover your nose and mouth with a tissue. Remember to wash your hands frequently.

Will Medicaid and the Children’s Health Insurance Program (CHIP) cover the 2009 H1N1 flu vaccine?

Yes. Medicaid and CHIP cover the 2009 HIN1 flu vaccine.Medicaid and CHIP will cover both a single dose of the seasonal flu vaccine and one or more doses of the 2009 H1N1 flu vaccine, if more than one dose is needed.

Talk to your doctor to find out how many doses you will need.Children and pregnant women will get the vaccine free of charge. Adults are covered if they get the vaccine at a public health department, physician office, Federally-qualified health center, or rural health clinic, but they may have to pay a small copayment.

You may get the vaccine at a hospital, but it’s only recommended if you can’t get to another site.

Your state is working with your local public health department to make it easy for you to get a vaccine. To find the most convenient site for you, call or visit your state’s public health department Web site. A listing of state public health departments can be found by visiting www.cdc.gov/h1n1flu/states.htm.

What if I get the 2009 H1N1 flu?Contact your doctor for advice on how to treat the 2009 H1N1 flu.
Medicaid and CHIP will cover your care, including an evaluation, any required tests, and your treatment. Children under 18 and pregnant women will get care free-of-charge while other adults may have to pay a small copayment.
There are drugs your doctor may prescribe for treating both seasonal and H1N1 flu called “antiviral drugs.” These drugs can make you better faster and may also prevent serious complications. This flu season, antiviral drugs are being used mainly to treat people who are very sick, such as people who need to be hospitalized, and to treat sick people who are more likely to get serious flu complications. Remember, most people with the 2009 H1N1 flu have had mild illness and haven’t needed medical care or antiviral drugs, and the same is true of seasonal flu.

Some states have preauthorization requirements for antiviral medications, such as Tamiflu or Relenza. This means that the prescription must be approved by the State where you live. This approval process can take 24 hours. If you are prescribed an antiviral medication, you are entitled to get at least 3 days worth of the prescription right away. The CDC recommends a full 5-day course of antiviral medication, so if you are unable to get 5 days worth of the prescription right away, make sure to go back to the pharmacy after 24 hours to pick up the rest.

Where can I find more information about the 2009 H1N1flu, including how the virus is spread and how to prevent it?

For more information about the 2009 H1N1 flu, visit www.flu.gov or the Centers for Disease Control Web site at www.cdc.gov/h1n1flu/general_info.htm. You can also call 1-800-CDC-INFO (1-800-232-4636) for more information.Where can I find out more about Medicaid or CHIP?


Call your State Medical Assistance (Medicaid) office for more information. Call 1-800-MEDICARE (1-800-633-4227) and say “Medicaid” to get the telephone number for your State Medical Assistance office. TTY users should call 1-877-486-2048. You can also visit www.medicare.gov.

Will Medicare cover the 2009 H1N1 flu vaccine?Yes. Medicare will cover administration of the 2009 H1N1 flu. Your doctor or healthcare provider can’t charge you for the 2009 H1N1 vaccine because they received thevaccine for free.You pay nothing for the 2009 H1N1 vaccine’s administration if your doctor or health careprovider accepts assignment. Assignment means that your doctor, provider, or supplier hassigned an agreement with Medicare to accept the Medicare-approved amount as full payment for covered services. The Part B deductible and coinsurance don’t apply to the2009 H1N1 vaccine or its administration.

Where can I find out more about Medicare?

For more information about Medicare, visit www.medicare.gov. You can also call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

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