medicareadvocacy.org

Center for Medicare Advocacy, Inc.

Innovative Legal and Technical Consulting

 

Advancing fair access to Medicare and health care


 
Home l About Us l Contact Us l Site Search l Español l Resources l Donate             

www.MedicareWorks.org   

   

Support Real Reform Now  


  

ALJ/MAC Decision Database


PRINTER FRIENDLY
 

Swine Flu, Seasonal Flu, and Medicare
 

Since March, 2009 the Novel H1N1 Influenza virus (colloquially known as Swine Flu) has been causing significant health concerns around the world.[1]  Every state in the U.S. has reported confirmed cases of H1N1 infections, with widespread activity continuing throughout the spring and summer months.[2]  On June 11, 2009 the World Health Organization (WHO) raised the worldwide pandemic alert level to phase six, the highest level, reflecting the spread of the H1N1 virus.[3]  Since the WHO declaration the H1N1 virus has continued to spread with significant localized outbreaks in some cases.  The United States continues to be the leader in reported cases of H1N1 infections of any country but most patients have recovered without medical treatment.[4]

 

The June 11, 2009 phase six alert issued by the World Health Organization (WHO) signaled a full scale pandemic of the H1N1 virus.[5]  In preparation for the upcoming flu season, the H1N1 virus has been isolated to manufacture an effective vaccine.[6]  Clinical trials on candidate vaccines are well underway.  The newest clinical trials are showing that the H1N1 vaccine will be effective in adults after only one dose, rather than two, as was originally predicted.[7]  The first available type of H1N1 vaccine will be a FluMist nasal spray manufactured by MedImmune.  The FluMist nasal spray vaccine has not been approved for people over age 50, people with asthma, or very young children.[8]  Doses of injectable vaccine are predicted to begin shipping by Mid-October and are approved for all age groups.[9]

 

Who Should Get Vaccinated for H1N1 First?

 

The Centers for Disease Control and Prevention recommends that the following groups be vaccinated first against the H1N1 virus:

  • Pregnant women

  • Caregivers for children younger than 6 months of age

  • Healthcare and emergency medical services personnel

  • All people from 6 months through 24 years of age

  • People aged 24 through 64 years who have a chronic condition which makes them susceptible to medical complications from flu illnesses

Studies indicate that the risk of infection of H1N1 amongst those age 65 and older is less than that for those in younger populations, however once demand among the most at risk populations has been met, those 65 and older are encouraged to be vaccinated.[10]

 

Medicare Coverage for "Regular" Seasonal Flu and H1N1 Vaccines

 

  • Medicare will pay for seasonal flu vaccines even if the vaccinations are given earlier in the year than normal.

Typically, the seasonal flu vaccine has been given in the fall or winter.  The Medicare program is aware that cases of swine flu are already beginning to surge and has notified the Medicare claims processing contractors to expect and prepare for earlier-than-usual seasonal flu claims.[11]  Traditionally, Medicare Part B has paid for a seasonal flu vaccine once every 12 months but Medicare will pay for another flu vaccine within the 12 month period since it is medically necessary and within the H1N1 pandemic plan.[12]   

  • Medicare will pay for additional flu vaccinations if both a seasonal flu vaccine and an H1N1 flu vaccine are necessary.

In a typical year, only one influenza vaccine has been necessary to protect individuals from the seasonal flu. If additional flu vaccines are necessary, as is necessary this year against H1N1 flu, these vaccines will also be covered by Medicare Part B.[13] It is estimated that there will be widespread availability of the H1N1 vaccine during the first full week of October.[14]

  • The antiviral medications that are effective against swine flu, Tamiflu and Relenza, are covered under most Medicare Part D plans.

The Centers for Disease Control and Prevention's (CDC) Division of the Strategic National Stockpile is releasing one-quarter of its antiviral drugs, personal protective equipment, and respiratory protection devices to help states respond to the pandemic.  The CDC has not issued a recommendation to wear masks, reporting that masks provide little more than psychological benefit and may actually be more dangerous, prompting people to take risks - like neglecting to properly wash their hands - if they are under the impression the mask will protect them.[15]

Reminders about H1N1

 

This new flu strain, H1N1, is a novel virus against which humans have no natural immunity.[16]  Symptoms of the swine flu are:

  • A fever of more than 100 degrees Fahrenheit,

  • Coughing, joint aches, severe headaches, lethargy, and lack of appetite, and

  • In some cases, a runny nose, sore throat, nausea, vomiting, and diarrhea.[17]

Human-to-human transmission of the swine flu occurs through coughing, sneezing, or coming into contact with a person or object with the virus. [18] Although it is commonly known as Swine Flu, people do not become infected with H1N1 by eating pork or pork products.  The best ways to prevent the spread of flu are frequent hand washing, covering coughs and sneezes, and staying home when feeling sick.[19] Young children, pregnant women, and people with chronic diseases like asthma, diabetes, or heart disease may be at higher risk for complications from this infection.[20]

 

In order to diagnose swine flu, a respiratory sample must be taken within the first four to five days of illness.[21]  The samples must be sent to the CDC laboratory.   A doctor who suspects swine flu may prescribe either Tamiflu (Oseltamivir) or Relenza (Zanamivir), both of which appear to be effective against this strain of swine flu when they are taken early.[22] 

 

People who suspect they have swine flu are advised to contact their physician to be tested.   For updates please refer to the CDC website: http://www.cdc.gov/swineflu/.

 

[1] Fox, Maggie. “WHO Ready to Warn of Imminent Pandemic.” 29 Apr. 2009. Reuters http://news.yahoo.com/s/nm/20090429/ts_nm/us_flu.

[2] 2009 H1N1 Flu: Situation Update. Centers for Disease Control and Prevention, 11 Sept. 2009. Web. 11 Sept. 2009. <http://www.cdc.gov/h1n1flu/update.htm>.

[3] Flu.gov: Know What To Do About the Flu. Health and Human Services. Web. 15 Sept. 2009. <http://www.pandemicflu.gov/general/index.html#what>.

[4] Flu.gov: Know What To Do About the Flu. Health and Human Services. Web. 15 Sept. 2009. <http://www.pandemicflu.gov/general/index.html#what>.

[5] Neergaard, Lauren. “US Swine Flu Cases Near 100, Obama Mourns Death in Texas; Spread Deepens in Europe.” 29 Apr. 2009. Associated Press. 29 Apr. 2009

[6] Questions & Answers 2009 H1N1 Influenza Vaccine. Centers for Disease Control and Prevention, 28 Aug. 2009. Web. 11 Sept. 2009. <http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm>.

[7] McNiel, Donald G. "One Vaccine Shot Seen as Protective for Swine Flu." New York Times. 11 Sept. 2009. Web. 11 Sept. 2009. <http://www.nytimes.com/2009/09/11/health/11vaccine.html?_r=1&scp=1&sq=swine%20flu%20vaccine%20one%20dose&st=cse>.

[8] Fox, Maggie. "First U.S. Swine Flu Vaccines Will Be Nasal Sprays: CDC." Canada.com. Reuters, 18 Sept. 2009. Web. 23 Sept. 2009. <http://www.canada.com/health/First+swine+vaccines+will+nasal+sprays/2009121/story.html>.

[9] Reinberg, Steven. "1st Doses of Swine Flu Vaccine Set for Early October." Health.com. 18 Sept. 2009. Web. 22 Sept. 2009. <http://news.health.com/2009/09/18/1st-doses-swine-flu-vaccine-set-early-october/>.

[10] 2009 H1N1 Vaccination Recommendations. Centers for Disease Control and Prevention, 11 Sept. 2009. Web. 24 Sept. 2009. <http://www.cdc.gov/h1n1flu/vaccination/acip.htm>.

[11] "Medicare Fee-For-Service (MFFS) Billing For the Administration of the Influenza A (H1N1) Virus Vaccine." MLN Matters. Centers for Medicare & Medicaid Services, 03 Sept. 2009. Web. 03 Sept. 2009. <http://www.cms.gov/mlnmattersarticles/downloads/SE0920.pdf>.

[12] Health and Human Services H1N1 Information Sharing Call 9/14/09

[13] "Medicare Fee-For-Service (MFFS) Billing For the Administration of the Influenza A (H1N1) Virus Vaccine." MLN Matters. Centers for Medicare & Medicaid Services, 03 Sept. 2009. Web. 03 Sept. 2009. <http://www.cms.gov/mlnmattersarticles/downloads/SE0920.pdf>.

[14] Health and Human Services H1N1 Information Sharing Call 9/14/09

[15] Haven, Paul. "Mexican's Put Faith in Masks-But Do They Work?" 28 Apr. 2009. Associated Press. 28 Apr. 2009 <http://news.yahoo.com/s/ap/20090428/ap_on_re_la_am_ca/lt_swine_flu_the_mask>.

[16] Kugler, Sara, and Christian Salazar. "Officials Say U.S. Deaths Expected From Swine Flu." 28 Apr. 2009. Associated Press. 28 Apr. 2009 <http://news.yahoo.com/s/ap/20090428/ap_on_he_me/med_swine_flu>.

[17] "Fact File: What You Need To Know About Swine Flu." MSNBC. 28 Apr. 2009. 28 Apr. 2009 <http://www.msnbc.msn.com/id/30390176/?pg=2#SwineFlu_QA>.

[18] "Fact File: What You Need To Know About Swine Flu." MSNBC. 28 Apr. 2009. 28 Apr. 2009 <http://www.msnbc.msn.com/id/30390176/?pg=2#SwineFlu_QA>.

[19] "Fact File: What You Need To Know About Swine Flu." MSNBC. 28 Apr. 2009. 28 Apr. 2009 <http://www.msnbc.msn.com/id/30390176/?pg=2#SwineFlu_QA>.

[20] "For Concerned Parents and Caregivers." 29 Apr. 2009. Center for Disease Control and Prevention. 29 Apr. 2009 <http://www.cdc.gov/swineflu/parents.htm>.

[21] "For Concerned Parents and Caregivers." 29 Apr. 2009. Center for Disease Control and Prevention. 29 Apr. 2009 <http://www.cdc.gov/swineflu/parents.htm>.

[22] "Fact File: What You Need To Know About Swine Flu." MSNBC. 28 Apr. 2009. 28 Apr. 2009 <http://www.msnbc.msn.com/id/30390176/?pg=2#SwineFlu_QA>.

 
 
 


All information is copyright Center for Medicare Advocacy, Inc.
Full Notice of Copyright and Legal Advice