Friday, September 22, 2023

Flu Shot Coverage Under Medicare

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What To Expect From Your Flu Shot

Medicare 2020 Spanish Flu Video Covered All Season Long (:06 Seconds)

You can get your annual flu shot from any pharmacy or provider who accepts Medicare. You can find the contact information for a pharmacy near youon SingleCare here. Call ahead if youre unsure whether Medicare is accepted.

One large study showed that people who received a high-dose flu vaccine were more likely to develop side effects during the week after vaccination compared to those who got a standard-dose flu vaccine. Common side effects include:

  • Headache
  • Muscle aches
  • Fatigue

However, another study found that the high-dose vaccine was 24% more effective in preventing influenza in seniors than standard-dose vaccines. In most cases, the risk of vaccine side effects outweighs the risk of flu complications.

Although it may be tempting to take a pain reliever before or after vaccination, you should ask your healthcare provider first. Common over-the-counter pain medications, such as Tylenol, aspirin, naproxen, and ibuprofen, have been shown to reduce the efficacy of flu vaccines. However, if you have been prescribed pain relievers, such as low-dose aspirin to prevent heart disease, you should always talk to your healthcare provider before discontinuing medication.

People aged 65 and older with underlying health conditions are now eligible for a COVID-19 booster shot. The CDC has stated that it is safe to get a COVID-19 vaccine or booster shot at the same time or in close proximity to getting a flu vaccine.

Which Vaccines Does Medicare Cover

Vaccines are important for preventing illness and keeping you well. Because vaccines may get less effective over the years, you may need to talk with your doctor about how frequently you should get certain ones.

Medicare Part B is the part of original Medicare that covers medical costs. It also covers several immunizations. These include:

  • hepatitis B vaccines
  • influenza vaccine

Everything You Need To Know About Getting Your Flu Shot With Medicare

If youre eligible for Medicare and have Medicare Part B or C then yes, Medicare pays for your flu shot as a preventive service. Your flu shot is covered by your Medicare B benefit, which, apart from some other preventive services, also helps cover doctor visits and various outpatient visits. The cost of 1 flu shot each flu season is covered under Part B under both Original Medicare and a Medicare Advantage plan, if you have one.

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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 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.

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Does Medicare Cover Flu Shots?

Medicare covers the full cost of yearly flu shots. To get the shot for free, be sure to use a provider that accepts your plan’s payment, whether you’re enrolled in Original Medicare or a Medicare Advantage plan. You must use a plan provider if you have a Medicare Advantage HMO, but PPO members are covered for both in-network and out-of-network flu shots.

If a second flu season breaks out in the same calendar year, your doctor may recommend you get a second shot. Both Original Medicare and Medicare Advantage plans cover a second vaccine if your doctor approves it.

Since the flu vaccine is free with Medicare, the main difference between plans is where you can get the shot. You won’t be charged for the shot as long as you use a provider covered by your plan.

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Where Can I Get Vaccines I Need

You can get most vaccines at a pharmacy, doctors office, clinic or community health center. Talk with your doctor about what vaccines you may need. Your doctor or Part D plan provider can also help you understand whether your cost will be affected by where you go to get the vaccines that your doctor recommends.

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.

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Medicare Part B Covers Preventive Services Including Flu Shots

Medicare Part B is your medical insurance. It covers preventive services, like the flu shot. Medicare pays for one shot per season but may cover a second if its medically necessary. Medicare coverage includes flu shots that are approved by the U.S. Food and Drug Administration for people over the age of 65. Covered flu shots include Fluad and Fluzone High-Dose, according to the CDC.

Dr. Ganguli recommends the high-dose flu vaccination for anyone older than 65.

There are other types of influenza vaccines approved for adults, however, not specifically for people over the age of 65. These can be given to people over 65 years of age if the high-dose flu vaccine is unavailable or not preferred for any reason. These include:

Medicare does not cover nasal spray flu vaccines, as the FDA has not approved them for this age group.

Medicare Part B also covers COVID-19 vaccines, a seasonal H1N1 swine flu vaccine, a pneumococcal vaccine, and hepatitis B shots for individuals considered high-risk.

Part B also includes certain shots if theyre related to treatment for illness or injury. For example, if your doctor treats an injury with a tetanus shot.

Does Medicare Cover Flu Shots

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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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Influenza Vaccination Coverage Adults 65 Years And Older United States

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  • Influenza vaccination coverage among Medicare fee-for-service beneficiaries aged 65 years is assessed using data files from the Medicare Fee-For-Service administrative claims data managed by the Centers for Medicare & Medicaid Services .
  • Weekly influenza vaccination coverage estimates were calculated using Kaplan-Meier survival analysis, based on beneficiaries enrolled as of August 1, 2019 and followed through May 31, 2020 for 2019-20 flu season and enrolled as of August 1, 2020 and followed through May 31, 2021 for 2020-21 flu season and enrolled as of Aug 1, 2021 and followed through December 31, 2021 for the 2021-22 flu season.

Medicare Coverage For The Pneumonia Vaccine

Most preventive vaccines are covered under Part D, the prescription drug part of Medicare. Medicare Part B covers a few specific vaccines, like the two pneumonia vaccines. Medicare Advantage plans, sometimes called Part C, also cover the pneumonia vaccines, along with other vaccines you may need.

If you are enrolled in original Medicare , or a Part C plan, you are automatically eligible for the pneumonia vaccines. Since there are two types of vaccines for pneumonia, you and your doctor will decide if you need one or both vaccines. Well get into the details of the two different types a little later.

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Medicare Part D Flu Shot Coverage

Medicare Part D prescription drug plans are optional, and plans offer different formularies , 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
  • MMR vaccine
  • BCG vaccine for tuberculosis

Important Points About Medicare The Flu And The Flu Vaccine

Medicare vaccine: Coverage, eligibility, and costs
  • Flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and sometimes the lungs. These diseases are transmitted through coughing, sneezing or talking.
  • Flu symptoms can mirror COVID-19. Fever, cough, shortness of breath, sore throat, muscle aches, headache and runny or stuff nose are common symptoms for both. If you get any of these, dont guess what you have contact your physician.
  • Most should get a flu shot but some should not. The Centers for Disease Control and Prevention recommend all persons aged six months of age and older get the annual vaccination, with rare exceptions. For example, those who have a life-threatening allergy to eggs or gelatin should consult their physicians.
  • The CDC recommends getting the vaccine in early fall before flu season begins. However, older persons should get the vaccine in the month of October. This may help ensure that the vaccine doesnt lose effectiveness as the peak of flu season approaches.
  • Medicare pays for the flu shot. Original Medicare Part B will cover the vaccination with no deductible or copayment. Medicare Advantage plans must also pay for the shot.
  • Doctors can administer the vaccine. If you have Original Medicare, you can get the flu shot at the office of any doctor who accepts Medicare assignment. Those with Medicare Advantage will probably need to visit a doctor in network in order for the plan to pay.
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    Cdc Shingles Vaccine Recommendations

    The Centers for Disease Control and Prevention recommends Shingrix vaccination for anyone 50 years and older, even if you have already had shingles, if you had another type of shingles vaccine, and if you dont know whether or not youve had chickenpox in the past.

    You should not get the vaccine if you are allergic to any of the components, are pregnant or breastfeeding, currently have shingles, or you have lab tests that definitively show that you do not have antibodies against the varicella-zoster virus. In that case, you may be better off getting the varicella vaccine instead.

    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.

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    Does Medicare Cover Other Vaccines

    Flu shots arent the only vaccines covered by Medicare.

    Medicare Part B and Medicare Advantage plans also cover preventive vaccines such as pneumonia shots and Hepatitis B shots. Medicare Part B and Medicare Advantage plans may also cover vaccines such as rabies shots if they are considered medically necessary by a doctor.

    Specific costs, including monthly premiums, deductibles and coinsurance 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 and get you enrolled in a plan that works for you.

    Find Medicare Advantage plans in your area

    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:

    Medicare has neither reviewed nor endorsed this information.

    Which Vaccines Should Older Adults Get And When

    Medicare 2020 Flu Ad Dad & Me (:15 Seconds)

    The Centers for Disease Control and Prevention has established a vaccination schedule for adults over 65. Other factors such as medical conditions and your history may affect these recommendations. Check with your doctor about which vaccines youll need.

    A typical vaccine schedule for older adults breaks down like this:

    Shingles vaccine: The CDC recommends you get two doses of the shingles vaccine Shingrix, 2 to 6 months apart. If you received a different shingles vaccine called Zostavax in the past, you still need the Shingrix vaccine. Zostavax is no longer in use in the United States.

    Pneumococcal vaccine: The CDC recommends a single shot of the pneumonia vaccine to those who need it. People with certain chronic medical conditions, such as chronic heart or lung disease, may need one or two additional shots.

    Flu vaccine: The flu shot is usually available in early fall, before flu season starts. Every year adults 65 and older should get the flu shot, not a nasal spray vaccine. The CDC also recommends older adults receive the high-dose quadrivalent flu vaccine.

    Tetanus, diphtheria, and pertussis : The CDC recommends adults 65 and older should receive the Tdap vaccine if theyve never had it before, followed by a booster every 10 years. If you need the shot as part of wound management , one dose is recommended.

    If youre over 65 and have additional risk factors, you may also need these vaccines:

    • Hepatitis A

    • Meningococcal A, C, W, Y

    • Varicella

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    Does Medicare Advantage Cover Flu Shots

    Medicare Advantage plans cover flu shots the same way as Original Medicare. You can get a free flu vaccine once per calendar year from any provider covered by your plan.

    You don’t need a referral to get an annual flu vaccine, even with a Medicare Advantage HMO.

    If there are two flu seasons within the same calendar year, Medicare Advantage plans cover a second vaccine if your doctor approves it.

    To be sure you’re covered, contact your Medicare Advantage plan to find out where you can go for your flu shot. With an HMO, for example, you need to stay within your plan’s provider network. If you have a PPO, you can go to an out-of-network provider and still get the shot for free.

    Is It Cheaper To Get A Vaccine At My Doctors Office Or A Pharmacy

    You may feel more comfortable getting shots at your healthcare providers office. Your provider knows your patient history and can provide a one-on-one experience. If you choose to get vaccinated at your providers office, keep in mind you may be billed for an office visit in addition to the cost of the shot.

    For the COVID-19 vaccine, your provider shouldnt charge you if the vaccine was the only service you received. You should ask for a refund if you believe you were billed in error for the COVID-19 vaccine.

    You can also get immunizations against flu, pneumonia, shingles, and other conditions at your local pharmacy. Youll be responsible for any copays or deductibles depending on your prescription drug plan, but you wont have an office visit copay.

    Plus, your vaccine record will be kept on file as part of your permanent pharmacy history. When you get vaccinated at your pharmacy, your information is entered into the state immunization registry, which can be accessed by your doctor, Dr. Schaffner says.

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