Vaccines Covered By Medicare Part B
Medicare Part B covers three important vaccines as part of its preventive care benefits.
Covered vaccines include the following:
- Flu vaccine: Annual vaccine given in one shot before or during flu season, usually November through April
- Pneumonia vaccine: One-time vaccine given in two shots at least one year apart
- Hepatitis B vaccine: One-time vaccine given in two to four shots over one to six months for people who are medium to high risk, including people with diabetes
Part B also covers vaccines you may need if youre exposed to a harmful virus or bacteria by accident. You might need a tetanus shot, for example, if you step on a rusty nail. Or you may need rabies shots if youre bitten by a stray dog.
Why Get A 2020 Flu Shot
People who are 65 and older are at high risk of having serious health complications from the flu.When people with Medicare get their yearly flu shot, it helps lower the number of medical visits, hospitalizations, and deaths. An essential part of protecting your health during this flu season is getting the flu shot.
This year, due to COVID-19, flu shots are more available than in the past. If youre having trouble finding a place to get your flu shot, find a location near you.
Can I Still Get The Flu If I’ve Been Vaccinated
Yes. Those who have been vaccinated may still get the flu. This can be caused by one or more of the following:
- Exposure to the virus before vaccination
- Exposure to the virus during the two-week period after receiving vaccination, before immunity develops.
- The possible strains of the flu that may be circulating are not included in the flu vaccine.
In the United States, the Food and Drug Administration reviews the flu data and determines the combination of viruses most likely to prevent the flu each year. Despite the amount of research that goes into the flu vaccine composition, the virus is constantly changing.
Therefore, the vaccine may not be a perfect match to the current circulating virus. The good news is, those who have been vaccinated generally have a milder case of flu than those who are unvaccinated.
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What To Do With The Flu
The worst of the flu symptoms generally dissIpate within four days, and full recovery can be expected in 7-10 days.
In addition to seeking out the aforementioned medications, those with the flu should stay home from work or school and avoid being around others. Bed rest, drinking an increased amount of fluids and a light diet are also recommended.
Current Flu Vaccine Recommendations For People 65 And Up
There are regular flu shots that are approved for people 65 and older and two that are specially designed for this group. One is the high-dose flu vaccine.
This vaccine, which is also known as Fluzone High-Dose, contains four times the amount of antigenthe inactivated virus that creates an immune responsethan a regular flu shot. Its linked to higher antibody production after the vaccine. Research has actually shown that older adults who receive this flu shot have 24% fewer cases of the flu than those who get the regular flu shot.
The other flu vaccine thats specially designed for the 65-and-up group is the adjuvanted flu vaccine, also known as Fluad Quadrivalent. Its formulated with an adjuvant, which is a special ingredient that creates a stronger immune response. The adjuvanted flu vaccine also creates a higher immune response than in people who get a standard flu shot.
When given a choice, most seniors opt for the high-dose, perhaps, because it has been on the market longer and more people are aware of it, Amesh A. Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, told Verywell.
The adjuvanted vaccine first became available in the U.S. during the 2016-2017 flu season.
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Seniors And The Flu Vaccine
Older adults are at higher risks of developing complications from the flu virus. According to the CDC, adults over the age of 65 account for 70 to 85 percent of seasonal flu-related deaths in the United States.7
It is important for seniors with weakened immune systems to get vaccinated in order to reduce the risk of developing serious medical problems from acquiring the flu.
For health adults over 65, the CDC recommends administration of the high dose flu vaccine .
Medicare Part B covers one flu vaccination each year. As long as the health care provider administering the vaccination accepts Medicare assignment, you will pay nothing for it.
For those already affected by the flu, there are four medications that are available by prescription only.
While over-the-counter flu medicines can work against flu symptoms, these three drugs are proven to more effectively shorten the severity and duration of flu symptoms.
The CDC reports that all three drugs have been shown effective against this years anticipated flu strains. However, the drugs are only effective if taken within two days of contacting the flu virus.
These drugs are not covered by Original Medicare but may be covered by a Medicare Advantage plan with prescription drug coverage or a Medicare Part D plan.
Other Ways To Avoid The Flu
The flu is an airborne virus that can be passed in droplets of breath, but it is most commonly transmitted by the hands. In addition to getting vaccinated, you should:
- Be extra diligent about washing your hands during flu season, including before meals.
- Avoid coughing or sneezing into your hands. Instead, do it into a tissue or into the sleeve of your shirt. If you do cough or sneeze into your hands, go wash them as soon as possible.
- Avoid crowded public places that involve close physical contact with numerous other people.
- Get plenty of sleep.
- Avoid touching your eyes, nose and mouth.
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Which Medicare Plans Cover Vaccines
Medicare divides its coverage into parts, and each part covers specific medical costs. Heres what each Medicare part may cover or not cover when it comes to vaccines:
- Part A.Part A is the part of original Medicare that covers hospital and inpatient stays. It doesnt usually cover vaccines. Even if youre in the hospital and get a flu shot , the hospital will still bill your Medicare Part B plan.
- Part B.Part B is the portion of original Medicare that pays for most medical costs. The vaccines that Medicare covers are listed above.
- Part C. Medicare Advantage is an alternative to original Medicare . Medicare Advantage plans must cover all the vaccines that original Medicare does.
- Part D.Part D is the portion of Medicare that pays for prescription drugs. It will cover vaccines if Medicare Part B doesnt cover them. Your Part D formulary should explain which vaccines your plan covers.
- Medigap.Medigap is Medicare supplement insurance that helps cover the out-of-pocket costs related to healthcare. Medigap doesnt pay for vaccine costs because you dont have out-of-pocket costs when getting vaccines approved under Part B.
Its always a good idea to know how Medicare may pay for your vaccine before you get it. Sometimes, Medicare may have certain rules: For example, you might need to get the vaccine from a certain company or at a Medicare-approved facility.
So It Offers More Protection From The Flu
Exactly. A 2014 study published in The New England Journal of Clinical Medicine, which involved more than 30,000 adults aged 65 and older, found that participants who received the high-dose flu vaccine had 24% fewer flu illnesses compared to those who got the standard flu vaccine.
Another study, carried out during the 2013-2014 flu season and published in The Lancet Respiratory Medicine in 2017, found that the high-dose flu shot was associated with a lower risk of hospital admissions compared with the regular flu shot in people age 65 and over. This was particularly true for those living in long-term care facilities.
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Medicare Coverage For Shingles Vaccine
Shingrix is not the first shingles vaccine, but it is the only one currently on the market in the United States.Instead of using a live virus,the vaccine uses a protein from the virus to trigger an immune response. It is administered in two doses two to six months apart.
This shingles vaccine has been shown to decrease the risk for shingles by 97% for people between 50 and 69 years old and by 91% for people 70 and older. It reduces complications as well. The risk for post-herpetic neuralgia goes down by 91% and 89%, respectively, in those age groups.
Because the vaccine works well, it is important to know if and when Medicare covers it.
Why Is Getting Your Flu Shot So Important
It is important to get your annual flu shot for many reasons. First and foremost is that the flu vaccine can help prevent you from getting the flu. Second, according to the CDC, vaccinated people are less likely to go to the doctor for the flu2 and also have a reduced risk of hospitalization with the fluby 33% in adults age 65 and older.3 The flu shot can also help protect or reduce the effect of flu symptoms in people with chronic health issues related to heart disease,2 as well as people who have diabetes.3
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How To Learn More About Medicare Coverage For Pneumonia Vaccines And Other Preventative Services
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Protection From The Flu
The seasonal flu vaccine is available at no cost to Aetna members who have benefits that cover preventive services.
The vaccine is available for adults and for children 6 months and older. Children aged 6 months through age 8 who have never had the vaccine or have only had one dose in their lifetimes should have two doses of the flu vaccine, with at least four weeks between doses.
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Where Can I Get More Information
Your doctor or pharmacist can provide more information about this vaccine. Additional information is available from your local health department or the Centers for Disease Control and Prevention.
This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.
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Vaccines Covered By Medicare Part D
Medicare Part D covers all commercially available vaccines needed to prevent illness. You can get Part D coverage through a stand-alone Medicare prescription drug plan or a Medicare Advantage plan that includes drug coverage.
Vaccines covered by Part D include the following:
- Shingles vaccine: One-time vaccine given in two shots over two to six months
- Tdap vaccine : One shot if youve never been vaccinated, and a booster every ten years
- Other vaccines covered: Vaccines that are “reasonable and necessary” to prevent illness and are not covered by Part B
Part D may also cover vaccines you may need if you are traveling internationally. Talk with your doctor about your travel plans and ask what vaccines are recommended.
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How Safe Is Fluzone High
Some side effects were reported more frequently after vaccination with trivalent Fluzone High-Dose than after standard-dose inactivated flu vaccines. The most common side effects experienced during clinical studies were mild and temporary, and included pain, redness at the injection site, headache, muscle aches, and malaise. Most people had minimal or no side effects after receiving the Fluzone High-Dose. In a study comparing Fluzone High-Dose Quadrivalent with trivalent Fluzone High-Dose, some of these side effects were slightly more common with the quadrivalent vaccine, but most were mild and resolved within a few days.
Does Medicare Cover Flu Shots
Flu shots are essential to protect your health during the fall and winter months.
Flu season typically begins in November and lasts through April. The highest number of cases usually occurs between December and February. Influenza, informally called the flu, causes fever, cough, sore throat, headaches, fatigue, and body aches.
For those older than 65, the flu is dangerous and potentially life-threatening. This population has the highest risk of developing complications from the flu, according to the Centers for Disease Control and Prevention , which can lead to hospitalizations and even death. During the 2018-19 flu season the last normal flu season42.9 million people got sick 647,000 were hospitalized and 61,200 died in the United States. Ninety percent of all hospitalizations from the flu occurred in people over the age of 65 years old, according to a study co-authored by CDC and published in 2019. The statistics for the previous two years are lower than typical due to the impact of the COVID-19 pandemic.
Getting an annual flu shot is the single, best way to prevent the seasonal flu and its complications, according to the CDC. Some people who get the flu shot might still get sick however, a study published in 2018 found that people who did get the flu after getting the vaccine had milder symptoms and a reduced risk of being hospitalized.
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Why You Should Get A Flu Shot
Getting your annual flu shot is especially important if youre 65 or older because seniors tend to get sicker from the flu compared to younger adults.
During a typical flu season, people 65 years and older account for 70 percent to 85 percent of flu-related deaths and more than half of flu-related hospitalizations, according to the CDC.
The CDC recommends people get a flu shot by the end of October.
Getting a flu shot too early such as in July or August can reduce the vaccines effectiveness later in the flu season, particularly for older adults.
Flu symptoms often mirror those of COVID-19.
Common flu symptoms include:
- Headache
- Runny or stuffy nose
Getting the flu or COVID-19 can be serious, but getting both can be deadly especially for older Americans.
Medicare also covers the coronavirus vaccine at no cost to you. You can get vaccinated for both COVID-19 and the flu but not at the same time.
According to the CDC, COVID-19 vaccines should be given alone with at least 14 days either before or after you get any other vaccine, including the flu shot.
Flu shot side effects are typically temporary and mild.
Flu shot side effects may include:
- Pain, redness or swelling around the injection site
- Tiredness
Do You Need The Flu Shot If You’ve Received The Covid
Video transcript
If youve already gotten the COVID-19 vaccine, it is also recommended and important that you get the flu shot this year. One covers you against the influenza virus, and the other covers you for the COVID-19 viruses. Theyre two distinct vaccines.
Every year, the flu vaccine is different.
This year, we suspect that the cases for the flu may increase.
Once you get the flu shot, it takes two weeks to become effective in your system. So the earlier you get it, the less exposure you have to others who are sick within your community.
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Who Should Get Vaccinated Against Influenza
Yearly influenza vaccination is recommended for people aged 6 months and over. Anyone who wants to protect themselves against influenza can talk to their immunisation provider about getting vaccinated.
The Australian Immunisation Handbook includes more information about specific groups who should get vaccinated against influenza.
The following people are more at risk of complications from influenza and are eligible for annual influenza vaccination free under the National Immunisation Program:
- Aboriginal and Torres Strait Islander people aged 6 months and over
- Children aged 6 months to under 5 years
- Pregnant women at any stage of pregnancy
- People aged 65 years or over.
- People aged 6 months or over who have medical conditions that mean they have a higher risk of getting serious disease:
- cardiac disease
- haematological disorders
- children aged six months to 10 years on long term aspirin therapy.
Children under nine years receiving their influenza vaccination for the first time require two doses of vaccine, spaced by a minimum of one month.
In some states and territories, influenza vaccines may also be provided for free to other people not listed above. Speak to your immunisation provider or contact your state or territory Department of Health to find out.
People who are not eligible for a free vaccine can purchase the vaccine from their immunisation provider.