Does Medicare Cover Flu Shots?
Medicare does cover flu shots for those enrolled in Part B or Part C (Medicare Advantage) plans. You can get Medicare-covered flu shots at a pharmacy or doctor’s office that accepts Medicare payment.
The COVID-19 pandemic has put immunizations to the top of everyone’s mind. But it’s easy to forget that another virus causes lots of pain and suffering, especially among seniors: influenza.
According to the Centers for Disease Control and Prevention, those over age 65 have the highest risk of developing serious and potentially fatal complications from the flu. The CDC reports that, during the 2019-2020 flu season, there were up to 56 million cases of the flu resulting in up to 26 million medical visits, 740,000 hospitalizations and 62,000 deaths.1
Flu season typically runs from December to February, but cases can appear both earlier and later in the year, even into the spring months of April and May. The best way to prevent getting sick from the flu is with a flu shot. Even those who do get sick experience milder symptoms and have a much lower risk of being hospitalized.
Physicians recommend getting the flu shot in the fall, from September to November. This gives your body the time it needs to build immunity before the viruses become most abundant in winter.
Does Medicare Pay for Flu Shots?
Yes, Medicare covers flu shots. Medicare has several parts, and each part doesn’t cover the flu shot, however. Let’s break it down, part by part.
Medicare Part A Flu Shot Coverage
Medicare Part A covers inpatient care you receive during hospitalizations, at skilled nursing facilities, hospice and some home health care. It does not cover the flu shot, however.
Medicare Part B Flu Shot Coverage
Medicare Part B is your medical insurance. It covers outpatient care and preventive services, which includes the flu shot. Part B is optional, and some people who have employer-sponsored insurance after age 65 may often opt out of Part B, at least until their other insurance ends.
Part B pays the full price for one flu vaccine per season, and may cover a second vaccination if your doctor deems it medically necessary. This covers flu shots that are approved by the U.S. Food and Drug Administration (FDA) for people over age 65.
Medicare Part B also covers a seasonal H1N1 swine flu vaccine, as well as the pneumococcal vaccine to prevent pneumonia. Medicare Part B also fully covers the COVID-19 vaccine.
Medicare Part C (Medicare Advantage Plans) Flu Shot Coverage
Medicare Part C (Medicare Advantage) include both Part A and B benefits. These plans are sold by private insurance companies and replace your Original Medicare coverage (Parts A and B).
Because Part B benefits are included, Medicare Advantage plans cover flu shots. Medicare Advantage plans may also offer some additional benefits, such as hearing, dental and vision care. Most Medicare Advantage plans include prescription drug coverage.
Medicare Part D Flu Shot Coverage
Medicare Part D prescription drug plans are optional, and plans offer different formularies (the list of drugs it will pay for), copayments, coinsurance and deductibles. Some Part D plans even offer $0 deductibles.
Medicare Part D plans the flu shot, along with many other vaccines. However, you need to have Part B in order to have Part D as well. And when you have Part B, it will pay the full price for your flu vaccine.
Part D coverage will pay for other vaccinations, such as:
- Shingles vaccine
- Tdap vaccine for tetanus, diphtheria, and pertussis (also called whooping cough)
- MMR (measles, mumps, rubella) vaccine
- BCG vaccine for tuberculosis
- Meningococcal vaccines
- Hepatitis A and hepatitis B vaccines for individuals considered high-risk
What Is and Isn’t Covered
Medicare Part B and Medicare Advantage plans cover the full cost of the flu shot if you use a doctor, other provider or pharmacy that accepts Medicare payments. If you are using a pharmacy or provider for the first time, be sure to ask if they accept Medicare assignments before making an appointment.
Medicare only covers the flu shot. It does not cover nasal spray flu vaccines, because the FDA has not approved them for this age group.
If you do not have Medicare Parts B or C, or other health insurance, a dose of flu vaccine may cost between $139 and $160, depending on the pharmacy, according to the web site Singlecare.com. Some pharmacies may offer seniors a discounted price of about $70 for a flu shot.
In addition, a local senior center or your local health department may hold clinics to provide free flu shots to those without insurance. Check with them during flu season.
Providers That Accept Medicare for Flu Shots
Medicare Part B covers the cost of your annual flu shot as long as you visit a provider who accepts Medicare.
A Medicare provider could be your doctor or a medical clinic, but it might also include health care providers and clinics at retail locations such as Wal-Mart, some grocery stores and retail pharmacies such as Walgreens, CVS and others.
Check with your local flu shot providers and ask if they accept Medicare before getting your flu vaccination.
Medicare Supplement (Medigap) Plans Can Cover Medicare Costs When You Get the Flu
If you get the flu or another illness and your treatment is covered by Medicare, you may likely face out-of-pocket Medicare costs such as deductibles, coinsurance and copayments.
A Medicare Supplement Insurance (Medigap) plan can help pay for these costs.
For example, each of the 10 standardized Medigap plans that are available in most states help cover the Medicare Part B coinsurance or copayments you might face when you receive covered flu treatment.
Learn more about common procedures that medicare covers.
A licensed agent can help you decide on a Medicare option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.
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