Monday, September 25, 2023

Where To Get A Flu Shot With Medicare

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How Long Does The Flu Shot Last & Why Do I Need It Every Year

Provider Compliance: Medicare Flu Shot Payment & Billing Overview

A flu vaccine is needed every year for two reasons. First, a persons immune protection from vaccination declines over time, so an annual flu vaccine is needed for optimal protection.

Second, because flu viruses are constantly changing, the composition of flu vaccines is reviewed annually and are updated to protect against the viruses that research indicates will be most common during the upcoming flu season.

For the best protection, everyone 6 months and older should get vaccinated annually.

Get the facts about the flu

When Should I Get A Flu Shot

According to the Centers for Disease Control and Prevention , younger people can get the flu shot as early as July or August. But for older adults, getting the vaccine too soon can reduce its effectiveness later in the season.

If you’re 65 or older, the CDC recommends getting the vaccine in September or October, before the flu begins to spread. But you can still be protected even if you get the vaccine in November or later.

Medicare covers the vaccine at any time during flu season.

Can The Flu Shot Make Me Sick

No, flu vaccines cannot cause flu illness. Some people report having mild side effects after flu vaccination, such as:

  • Low-grade fever
  • Arm pain at the injection site

To help ease the pain and avoid the symptoms, you can take a pain reliever like Tylenol or Ibuprofen for muscle aches, headaches and a low-grade fever.

For arm pain, apply a cool compress and keep your arm moving after the shot.

Get the facts about the flu

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What Does This Vaccine Do That Others Haven’t Been Able To

Using conventional production methods, it wouldn’t be possible to target the full spectrum of flu viruses. But mRNA vaccines can include at least 20 different antigens for essentially the same cost as a single one, said Hensley, a microbiology professor at Penn’s Perelman School of Medicine.

Researchers were pleasantly surprised that their vaccine could effectively target so many different strains at once and, at least in animals, generate an immune response against all of them simultaneously.

“To have 20 and have robust immune responses to each was very interesting to me,” said Alyson Kelvin, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan, who was not involved in the research, but wrote an accompanying column. “It’s something I didn’t think was possible.”

In mice and ferrets, which are used in flu studies because they can catch the same influenza strains we can, the vaccine looked just as safe as the typical flu vaccine.

It’s not yet clear how this vaccine might be used, she said. Potentially, it could be updated every few years as the circulating strains change, or maybe even more than 20 lineages could be included: “I don’t know what the limit is.”

Where To Get Your Shots

Medicare Part B Benefits

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

  • Your doctors office. At your next appointment, ask for a flu shot. Out-of-pocket costs 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.

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Medicare Part A Covers Hospital Staysflu Shot Not Included

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.

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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Scenario: Billing For Influenza And Pneumococcal Vaccines

If influenza vaccine and pneumococcal vaccine are administered at the same encounter, can an administration fee be billed for each vaccine?

The Centers for Medicare and Medicaid Services address this question in its guide on Medicare Part B Immunization Billing.

When a beneficiary gets both the seasonal influenza virus and pneumococcal vaccines on the same visit, do I continue to report separate administration codes for each type of vaccine?

Yes, see for individual Change Requests and coding translations for ICD-10. Use separate administration codes for the seasonal influenza virus and pneumococcal vaccines. Medicare pays both administration fees if a beneficiary gets both the seasonal influenza virus and the pneumococcal vaccines on the same day.

1/11/16Pneumococcal vaccine administeredG00091Z23

When Should I Get The Flu Shot

Medicare & You: Flu Prevention

Early fall is the best time to get your flu shot. Getting vaccinated early is important, because the flu is highly contagious and spreads rapidly.

Getting the shot before the flu season is in full force gives the body a chance to protect itself. Peak months for the flu season in Michigan are November, December, January, February, March and April.

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Nc Immunization Program/vaccines For Children

Under NC Immunization Program/Vaccines for Children guidelines, the NC Division of Public Health Immunization Branch distributes all childhood vaccines that are recommended by the Advisory Committee on Immunization Practices to local health departments, federally qualified health centers , rural health clinics , hospitals and private providers.

For the 2022-2023 influenza season, NCIP/VFC influenza vaccines are available at no charge to providers for children six months through 18 years of age who are eligible for the VFC program, according to the NCIP coverage criteria. The current NCIP coverage criteria and definitions of VFC categories can be found on DPHs Immunization Branch web page.

For providers interested in enrolling in the VFC program, information can be found on the CDC information page and the NC DPH website.

Eligible VFC children include ALL Medicaid beneficiaries and any Medicaid or NC Health Choice beneficiaries who are American Indian and Alaska Native . These beneficiaries can be identified as AI/AN in one of two ways:

  • They are either identified as MIC-A and MIC-S on their NC Health Choice Identification Cards or,
  • Beneficiaries/parents may self-declare their VFC eligibility status according to NCIP/VFC program policy.
  • All other NC Health Choice beneficiaries are considered insured and must be administered privately purchased vaccines.

    Who Should Get A Flu Shot

    The CDC recommends a yearly flu shot for almost all adults and children 6 months of age and older unless you’ve had a severe, life-threatening reaction to a flu shot in the past, which is rare. Talk with your doctor about whether the flu shot is safe for you if you’ve had a severe reaction in the past or are allergic to eggs.

    While everyone should get a yearly flu vaccine, it’s especially important if you’re age 65 or older because you’re in the age group with the greatest risk for serious complications. Your risk is further increased if you have certain medical conditions, including:

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    When Should I Get My Influenza Vaccination

    The Centers for Disease Control and Prevention recommends that most people 6 months and older get a flu shot each flu season, ideally in September or October, so it can be fully effective when cases begin to rise every October. The CDC recommends adults 65 years and older get immunized with a high-dose or adjuvanted vaccine.

    People 65 and older are at a higher risk of serious complications if they get the flu, including bacterial pneumonia, ear infections and sinus infections. It also can worsen chronic conditions such as asthma, congestive heart failure or diabetes.

    This guidance to get a high-dose or adjuvanted vaccine is new for the 2022 flu season. These types of vaccines offer greater protection to older adults, many with weakened immune systems because of age, CDC officials say. Older adults immune systems also build up fewer antibodies in response to standard vaccine doses, and those antibodies stay around for a shorter time compared with younger people.

    An adjuvant is a vaccine ingredient that helps promote a better immune response. It also can reduce the amount of virus needed for production of a vaccine, which can allow for greater supplies of the vaccine.

    Influenza Vaccination Coverage Adults 65 Years And Older United States

    Medicare Part B Benefits

    Back to Main Page | Doses Distributed | Child Coverage | Pregnant Persons Coverage | Adult Coverage | Medicare Beneficiaries Coverage | Adult Pharmacy and Medical Office Vaccinations

    • 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 May 28, 2022 for the 2021-22 flu season. May 28, 2022 for the 2021-22 flu season. Estimates for the 2022-23 season are expected to be added in early November 2022.

    *Estimates are based on data released by CMS on September 18, 2022. Overall includes persons categorized as Unknown for race/ethnicity category.

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    We take your privacy seriously. You can review and change the way we collect information below.

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    What Types Of Flu Vaccine Are Available

    While powerful vaccines have been around for a while, this is the first time theyve been recommended for people 65 and older. The three types of high-dose vaccines are:

    Fluad quadrivalent. This shot is an inactivated vaccine that consists of virus particles that have been grown in culture and then killed to destroy their disease-producing capacity, unlike live vaccines that use live pathogens. Its approved for people 65 and older to protect against influenza virus subtypes A and types B.

    It has the same amount of antigen as the standard shots but contains an adjuvant. The antigen is the part of the vaccine that helps your body build up protection against flu viruses, according to the CDC.

    Flublok quadrivalent. Approved for people 18 and older and recommended for those 65 and older, this is a recombinant vaccine, which means its manufactured by using a small piece of DNA from bacteria or yeast cells.

    Fluzone high-dose quadrivalent. This vaccine, also made from inactivated cultures and approved for people 65 and older, has four times the antigen of standard-dose inactivated flu vaccines.

    As with any vaccine, the high-dose and adjuvanted flu vaccines may result in temporary, mild side effects typical of standard-dose seasonal flu shots. Expected side effects can include pain, redness or swelling at the injection site, fatigue, headache and muscle ache. These symptoms typically go away within one to three days.

    Keep in mind

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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% to 85% 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:

    • 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 COVID-19 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

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    Doctors Offices Or Hospitals

    All Blue Shield and Blue Shield Promise members can get their flu shot from their primary doctor .

    You may need to call ahead of time to set up an appointment at your primary doctors office. Or you can ask to have the shot during your next visit. Your local hospital or community clinic may also be offering flu shots.

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

    Flu shots, Medicare Part D enrollment with Hy-Vee

    If youre eligible for Medicare and have 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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    Get More Information On Frequency & Coverage Coding And Billing

    HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the .

    DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.


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    How Much Does A Flu Shot Cost With Medicare

    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

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    Where To Get A Flu Shot

    Most Blue Shield of California and Blue Shield of California Promise Health Plan members can get their flu shot at no extra cost as part of their preventive care benefits.

    Some members may have to pay a low out-of-pocket cost for the shot. This applies to:

    • Some pre-Affordable Care Act or grandfathered plans
    • Some employer-sponsored, self-funded, or administrative services only plans

    To check how much a flu shot may cost, please log in to your account. You can view your preventive care benefits by clicking Benefits under the myblueshield tab.

    You can get an updated COVID-19 booster when you get the flu shot. Check if your location also offers COVID-19 boosters.

    Does Medicare Advantage Cover Flu Shots

    Flu Shots For Homebound Residents And Caregivers

    Medicare Advantage plans, which are often referred to as Medicare Part C, are offered by private insurance companies and typically include Part D, or prescription drug coverage. These plans provide a way to get additional Medicare benefits based on your individual needs.

    Medicare Advantage plans cover 100% of the Medicare-approved amount for an annual flu shot, says Christian Worstell, a North Carolina-based licensed insurance agent. Plus, he notes, Medicare beneficiaries with a Medicare Advantage plan typically wont have to pay a coinsurance or copayment for the flu shot. Thats true as long as you visit a doctor who accepts Medicare and the terms of your Medicare Advantage plan, he says.

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    Does Medicare Cover Shingles Vaccine

    Original Medicare doesnt cover shingles vaccines, but that doesnt necessarily mean youll have to pay for it out-of-pocket. The shingles vaccine is required to be one of the vaccines covered by Medicare Part D Prescription Drug plans.

    In fact, most vaccines are covered under your prescriptionplan, rather than by Original Medicare. You should check with your specificplan for information such as what your costs will be, which vaccines you canreceive, and where you can go to receive them. Like Original Medicare, some vaccinescovered by Medicare Part D Prescription Drug plans may have eligibilityrestrictions, so be sure to ask your healthcare provider if you qualify.

    Being properly vaccinated helps prevent you from catchingavoidable illnesses, and from spreading them to the people around you. Medicarevaccine coverage makes it easy and affordable to stay up to date with yourshots, so you have one less thing to worry about when it comes to your health. Ifyou have questions about eligibility, costs, or whether you should get avaccine, you should consult with your healthcare provider.

    Nothing on this website should ever be used as a substitutefor professional medical advice. You should always consult with your medicalprovider regarding diagnosis or treatment for a health condition, includingdecisions about the correct medication for your condition, as well as prior toundertaking any specific exercise or dietary routine.

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