Friday, September 29, 2023

Does Medicare Pay For Flu Shots

Must read

Where To Get Your Shots

Flu shots, Medicare Part D enrollment with Hy-Vee

You can get your flu and pneumonia shots at the following locations:

  • Your doctors office. Call your primary care physician and make an appointment. Your office visit copay may apply for the visit, but the shots will come at no cost.
  • A pharmacy. Call your local pharmacy before you go to make sure they offer flu and pneumonia shots. Youll also want to make sure that the pharmacy accepts your Medicare plan. Our pharmacy directory can help you find a location, too.
  • A community health center. You can check with your local health department to see if there are community health centers that offer these shots and accept your Medicare plan.

How Much Does The Flu Shot Cost

If you have Original Medicare coverage, the flu shot will cost you $0.

If youre wondering where you can get the flu shot, the answer is lots of places, including your doctors office or a local pharmacy. If you have a Medicare Advantage plan, contact the plan provider to find out where exactly you can go for your flu shot. Most places accept Medicare Advantage plans, according to

Does A Person With Medicare Get Flu Shots For Free

If a person has Medicare Part B, a Medicare Advantage plan, or private health insurance, they can get a flu shot for free.

The Affordable Care Act requires that insurance companies cover the cost of the flu shot. Plus, under the ACA, insurers cannot charge a copayment, per the Department of Health & Human Services.

A person should check with the site providing the shot to make sure they accept assignment from Medicare or accept Medicare Advantage. People with private insurance should check their plan to make sure they can get the shot from a particular location for free.

Some insurance plans cover the shot only if a person receives it from their doctor. Other plans provide coverage if the shot comes from certain other locations as well.

Recommended Reading: Side Effects Of Alka Seltzer Plus Cold And Flu

Can I Get A Free Flu Shot At Walgreens Or Cvs

Pharmacies across the country administer thousands of flu shots every year.

Most pharmacies including national chains such as CVS and Walgreens can bill for the flu vaccine if it participates in Medicare, or if its included in your Medicare Advantage plans network.

Check the pharmacys website to see if online scheduling is available for flu shot appointments. If it is, you can pick a date, complete the paperwork and arrive to the pharmacy at your scheduled time.

Its always smart to call your local pharmacy ahead of time to confirm that flu shots are available. This can save you a trip if the vaccine is out of stock.

Make sure to bring your red, white and blue Medicare card or your Medicare Advantage card with you to your appointment. Otherwise, you may be turned away because the pharmacy cant bill Medicare for the flu shot without your information.

Does Humana Cover Flu Shots

Medicare vaccine: Coverage, eligibility, and costs
  • Humana Medicare Advantage plans cover flu shots, as flu shots are required to be covered by all Medicare Part C plans. Learn more about the other benefits of Humana Medicare plans and how you can enroll in a plan where you live.

The CDC recommends all eligible individuals 6 months of age and older receive a flu shot every year. But will your Humana Medicare Advantage plan cover the flu shot?

The answer is yes. Flu shots are required to be covered by all Medicare Advantage plans, such as Humana Medicare plans. So rest assured that your Humana Medicare Advantage plans covers your flu shot.

You can use the CDC flu shot finder tool or the Humana Find a Doctor tool to locate a vaccine site near you.

Also Check: Uti And Flu Like Symptoms

More Information On Flu Shots

A flu shot is important in any year, but the COVID-19 pandemic has further highlighted the importance of vaccines.

The flu can be just as serious for some people and require hospitalization, said Blue Cross Blue Shield of Kansas City medical director Rebecca Gernon, MD, MPH. So we anticipate that the collision of influenza and coronavirus is going to be problematic.

Gernon also notes that many of the same conditions that make someone more vulnerable to developing serious symptoms of COVID-19, such as hypertension and diabetes, are the same conditions that can heighten ones flu risk.

Consult our complete guide to the 2021-2022 flu season for more information about this years flu and the vaccine.

If youre considering applying for a Blue Cross Blue Shield Medicare Advantage plan or switching Medicare Advantage plans, you can compare plan benefits, costs, network providers and more online by finding plans available where you live. You can also call to speak with a licensed insurance agent who can help you compare plans.

Are Flu Shots Free For Seniors

For seniors who have Medicare Part B, C, or D, one flu shot per year is free. Medicare will cover two flu shots if a second shot is deemed medically necessary by a healthcare provider. Some seniors, however, do not have these Medicare plans and might need to pay out of pocket for the flu shot.

Without Medicare, Medicaid, or other health insurance, the cost for Fluad or Fluzone High-Dose can range from $130 to $220 depending on your pharmacy.

Get Fluad coupons | Get Fluzone High-Dose coupons

Read Also: Should You Get A Flu Shot While Taking Antibiotics

Medicare Part C Flu Shot Coverage

Medicare Part C include both Part A and B benefits. These plans are sold by private insurance companies and replace your Original Medicare coverage .

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.

What Vaccines Are Covered By Medicare

Provider Compliance: Medicare Flu Shot Payment & Billing Overview

The following chart shows how some common vaccines are covered by Medicare.

Coronavirus 2019 – Part B You pay nothing for the vaccine, whether you receive 2 shots or only a single dose.
Influenza -Part B You pay nothing for 1 flu shot per flu season if your doctor accepts Medicare assignment.
Pneumococcal -Part B You pay nothing for 2 shots if your doctor accepts Medicare assignment.
Hepatitis B -Part B You pay nothing if youre at medium or high risk for Hepatitis B and your doctor accepts Medicare assignment.
-Medicare Advantage plans with drug coverage-Part D Coverage rules and costs vary by plan.
Tetanus -Medicare Advantage plans with drug coverage-Part D Coverage rules and costs vary by plan.

These are only a few of the most commonly recommended vaccines. Check with your doctor or health care provider if you have questions about a specific immunization or vaccine that is not listed here.

Medicare Part B also typically covers vaccines after youve potentially been exposed to a dangerous disease or virus. For example, your rabies shot may be covered by Medicare Part B if you are bitten by a dog.

Recommended Reading: Flu Shot Safe For Pregnancy

When Does Humana Pay For Flu Shots

Humana Medicare Advantage plans cover an annual flu shot in full, meaning you will not be charged a copayment or have a deductible applied, provided that you adhere to the network restrictions of the plan and other conditions.

Your Humana Medicare Advantage plan evidence of coverage will detail exactly how your flu shot will be covered, along with how your Humana Medicare plan covers other vaccines, such as hepatitis B shots and pneumococcal shots.

Humana Medicare Advantage plans are bound by a federal law that requires all Medicare Advantage plans to provide coverage for everything covered by Original Medicare . And if Original Medicare covers the service in full, the Medicare Advantage plan must as well, provided that certain restrictions are met.

Flu shots are covered in full by Medicare Part B if the health care provider administering the shot accepts Medicare assignment, meaning they accept Medicares reimbursement as full payment.

Its important to remember though that a standalone Humana Medicare Part D plan or a Humana Medicare Supplement Insurance plan will not cover your flu shot. Part D plans cover prescription drugs and do include certain vaccines, but not the flu shot. And Medigap plans do not cover any vaccines or medications. If you have Medicare Part B along with your Part D or Medigap plan, your Part B benefits will cover your flu shot.

Medicare Advantage Plans May Cover More Vaccines Than Original Medicare

Medicare Advantage plans are sold by private insurance companies as an alternative to Original Medicare.

Every Medicare Advantage plan must provide the same hospital and medical benefits as Medicare Part A and Part B, and most plans include Medicare prescription drug coverage.

MAPDs must help cover a number of commercially available vaccines that arent covered by Original Medicare when reasonably and medically necessary to prevent illness. However, specific rules of administration and costs will vary depending on the Medicare Advantage plan you enroll in.

A licensed insurance agent can help you compare Medicare Advantage plans in your area, including what vaccinations may be covered.

Find Medicare plans that cover your vaccinations

Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.

Where you’ve seen coverage of Christian’s research and reports:

You May Like: Cvs Flu Shot No Preservatives

Does Medicare Cover Flu Shots

Medicare Part B, one of the two parts of Original Medicare, covers 100% of the costs of seasonal flu shots once a year during the fall or winter. The Part B deductible does not apply to this service, so Medicare covers the shot as long as you are eligible for and enrolled in Original Medicare. As long as your doctor or healthcare provider accepts Medicare assignment, flu shots are fully covered. Providers may not charge you more than the Medicare approved amount. If you receive the shot from a provider that does not accept assignment, then you may be responsible for additional fees for the doctors services but not for the shot itself.

Medicare Part A Covers Hospital Staysflu Shot Not Included

Medicare Part B: Coverage and exclusions

Medicare Part A covers:

  • Home health care

It does not cover the flu shot.

Medicare Part A is free to eligible people aged 65 or older. Generally, if you or your spouse paid Medicare taxes for at least 10 years, this portion of Medicare is free. You can sign up for this starting three months before your 65th birthday. If you have been receiving social security benefits before your 65th birthday, you are automatically enrolled in Part A. Otherwise, you need to sign up for it either online or at a social security office.

Don’t Miss: Are Flu Shots Available At Rite Aid

What Is The Pneumonia Vaccine

There are currently two types of pneumococcal vaccines that cover different strains of a common type of bacteria that can lead to pneumonia. This type of bacteria poses risks for young children but can also be risky for those who are older or have compromised immune systems.

The two vaccines are:

  • pneumococcal conjugate vaccine
  • pneumococcal polysaccharide vaccine

According to recent data, the CDC Advisory Committee on Immunization Practices recommend that people who are 65 and older should get the Pneumovax 23 shot.

However, both vaccines may be needed in certain circumstances when there is greater risk. These situations can include:

  • if you live in a nursing home or long-term care facility
  • if you live in an area with many unvaccinated children
  • if you travel to areas with a large population of unvaccinated children

Here is a comparison between the two available vaccines:

Protects against 13 strains of Streptococcus pneumoniae Protects against 23 strains of Streptococcus pneumoniae
No longer routinely given to people 65 and older One dose for anyone 65 years and older
Only given if you and your doctor decide it is needed to protect you from risk, then one dose for those 65 and older If you were already given PCV13, you should get PCV23 at least 1 year later

Pneumonia vaccines can prevent serious infections from the most common strains of pneumococcal bacteria.

Possible side effects

Do I Need The Pneumococcal Vaccine

The Centers for Disease Control and Prevention recommends pneumococcal vaccination for all adults age 65 and older. There are two kinds of pneumococcal vaccines: Prevnar 13 and Pneumovax23. Both help protect against the pneumococcal bacteria that tends to cause serious infections in senior citizens. Talk with your doctor about which vaccine is right for you.

Read Also: Cvs Flu Shot Age Limit

Find Out How Medicare Pays For Flu Shots

Medicare is defined in 4 parts: A, B, C and D. The combinations of Medicare Parts A and B is known as the Original Medicare program. Medicare Part C is known as Medicare Advantage. Whether youre enrolled in the Original Medicare program or a Medicare Advantage plan, know that your flu shot is covered by Medicare.* The information below provides details about how Medicare covers the flu vaccine depending on the type of Medicare program youre enrolled in.

*The cost of the shot may be affected if the provider is out of your network.

Enrolled in an Original Medicare plan? Discover how your flu shot is covered.

Original Medicare is commonly known as traditional Medicare and is made up of 2 parts: Medicare Part A and Medicare Part B . This program is offered by the federal government and provides members with a flu shot without a deductible or copay. The flu vaccine must be given by a physician, pharmacist or healthcare provider who accepts Medicare. This means the healthcare provider has agreed to provide this service and accept payment from the Medicare program/plan at a set rate. It is best to call ahead to find out if Medicare pays for flu shots at your pharmacy.

Got a Medicare Advantage plan? Find out how your flu shot is covered.

How Effective Is The Flu Shot

Medicare & You: Flu Prevention

The CDC studies the effectiveness of the flu shot each year and its research shows that flu shots reduce the risk of illness by between 50% and 60%. A recent study showed that adults age 50 and over reduced their chances of being hospitalized for the flu by 57%.

The main factor affecting the vaccines effectiveness is whether each years vaccine matches the flu viruses found in the community.

Also Check: Vitamin D For Colds And Flu Dosage

Importance Of Flu Shots For Seniors

Americans are living longer than ever before. Eating well, staying active and working with your doctor to control any medical problems you might have will help you enjoy a healthy life well into your senior years. Still, aging takes a toll on your immune system making it less capable of fighting infections like the flu. As you get older, you’re more likely to catch the flu. You’re also more likely to develop serious problems like pneumonia if you come down with the flu. Americans 65 and older are more likely than any other age group to be hospitalized for the flu, and approximately nine out of 10 flu deaths in the U.S. occur in seniors, according to the Centers for Disease Control and Prevention .

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

Don’t Miss: Can You Take The Flu Shot Twice

Does Medicare Cover Pneumonia Shots

Medicare Part B typically covers pneumonia shots, which help prevent certain types of pneumonia.

Medicare Advantage plans also cover pneumonia shots. Many Medicare Advantage plans also cover prescription drugs and other benefits that Medicare Part A and Part B don’t cover.

Medicare typically covers 100 percent of the Medicare-approved amount of your pneumococcal vaccine .

Before getting your pneumonia shot, verify with your doctor that it is 100 percent covered by Medicare.

The Centers for Disease Control and Prevention recommends PPSV23 pneumococcal vaccinations for all adults who are 65 years of age or older.

There are currently two pneumococcal vaccines that have been approved for use for the prevention of pneumonia. Both vaccines are covered under Medicare Part B however, the order in which you receive them matters. Talk to your health care provider to learn more.

More articles

Popular Articles