RSV vaccine now available for infants and adults age 60-plus

The respiratory syncytial virus (RSV) is a common respiratory virus. Although it usually causes only mild, cold-like symptoms, RSV can be serious. Infants and older adults are more likely to develop severe RSV and need hospitalization. Vaccines are now available to protect some infants, young children and older adults and are covered under the HealthSelect of Texas^SM and Consumer Directed HealthSelect^SM medical plans.

Recommendations and coverage for infants and young children

RSV is the leading cause of hospitalization for U.S. infants. Fortunately, the U.S. Food and Drug Administration (FDA) recently approved a new vaccine for the virus. The federal Centers for Disease Control and Prevention (CDC) recommends that some pregnant women or their babies get vaccinated for RSV.

To protect their babies, the CDC now recommends that women who are 32 through 36 weeks pregnant during September through January get one dose of a new maternal RSV vaccine administered immediately before or during RSV season.

If the mother isn’t vaccinated, the CDC recommends a new RSV immunization for infants that has been shown to reduce the risk of both RSV-related hospitalizations and health care visits in infants by about 80 percent.

The CDC recommends the following RSV immunizations for infants and young children:

• Infants younger than eight months and born shortly before or during RSV season (typically fall through spring): one dose within one week of birth
• Infants younger than eight months not born during RSV season: one dose shortly before the start of their first RSV season
• A small group of children between the ages of 8 and 19 months: who are at increased risk of severe RSV disease, such as children who are severely immunocompromised: one dose in their second RSV season

For pregnant women, infants and children in these recommended groups, the HealthSelect of Texas^SM, HealthSelect^SM Out-of-State and HealthSelect^SM Secondary medical plans cover the RSV vaccine at 100% from in-network providers.

 

Consumer Directed HealthSelect^SM participants in these groups must meet the annual deductible before the vaccine is covered. After the deductible is met, they will pay coinsurance for the vaccine.

Recommendations and coverage for adults 60 and older

There are two RSV vaccines licensed by the FDA for use in adults 60 years and older in the U.S. If you’re 60 or older, your health care provider might recommend an RSV vaccination for you, especially if you have a weakened immune system, a chronic medical condition or if you live in a nursing home. If any of these applies to you, you might be at higher risk of severe RSV disease. The CDC recommends a single dose of the RSV vaccine for people 60 years and older, with no maximum age for getting the vaccine. Talk to your healthcare provider to see if the RSV vaccination is right for you.

For participants 60 years and older enrolled in the HealthSelect of Texas, HealthSelect Out-of-State, Consumer Directed HealthSelect or HealthSelect Secondary medical plan, the RSV vaccine from an in-network provider is covered at 100% by the plan.

For HealthSelect of Texas, HealthSelect Out-of-State and Consumer Directed HealthSelect plans, if you visit an out-of-network provider, out-of-network benefits will apply. Please note that prior authorization may be required for some drugs obtained through Blue Cross and Blue Shield of Texas, the administrator of the HealthSelect of Texas plans.

Questions?

If you have questions about coverage or need help finding an in-network provider, please call a Blue Cross and Blue Shield of Texas Personal Health Assistant toll-free at (800) 252-8039 (TTY: 711), Monday – Friday, 7 a.m. – 7 p.m. and Saturday, 7 a. m. – 3 p.m. CT.

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This article was updated in February 2024 to reflect changes in Consumer Directed HealthSelect coverage.