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Will Medicare Cover Flu Shots

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Why Is Getting Your Flu Shot So Important

Flu shots, Medicare Part D enrollment with Hy-Vee

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

  • Vaccine Effectiveness Studies, Centers for Disease Control and Prevention, last accessed August 13, 2021,, opens new window.
  • CDC Seasonal Flu Vaccine Effectiveness Studies, Centers for Disease Control and Prevention, last accessed August 13, 2021,, opens new window.
  • Vaccine Effectiveness: How Well Do the Flu Vaccines Work?, Centers for Disease Control and Prevention, last accessed August 13, 2021,, opens new window.
  • J. A. Udell et al., Association Between Influenza Vaccination and Cardiovascular Outcomes in High-Risk Patients: A Meta-Analysis, JAMA 23, No. 310 : 171120, accessed June 6, 2020, doi:10.1001/jama.2013.279206.
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    Why Get The Flu Vaccine

    Get your flu shot each year. Vaccines are developed each year based on which flu viruses will be most common. Dont wait until someone close to you gets the flu. Your body takes about 2 weeks after vaccination to develop protective antibodies. And in some cases, the flu can often be worse for older adults, especially those with chronic conditions, diseases that suppress the immune system, or respiratory problems. And no, you cant get the flu from the vaccine! The viruses in the flu shot are killed .

    How Much Do Vaccines Cost

    The cost for vaccines depends on which portion of Medicare is paying and what the vaccine is.

    You wont pay anything for vaccines that Medicare Part B covers. But if you have Medicare Part C , you should check with your insurance plan.

    You may need to get your vaccine from a plan-approved provider or pharmacy. If youre following the rules of your Medicare Advantage plan, you shouldnt have to pay anything for your vaccine.

    If you get a vaccine that Part D covers, your Part D insurance company will negotiate a price that includes the vaccine costs and its administration. The costs include:

    • dispensing fee
    • vaccine administration fee
    • vaccine ingredient costs

    Your doctor will bill your Part D plan directly. You may be responsible for costs that include a copayment or coinsurance.

    Sometimes, your plan may require you to pay your provider up front for the Medicare Part D vaccine, then submit a claim to your Part D plan for reimbursement. When this is the case, you may want to contact your plan before getting the vaccine just to confirm your coverage.

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    Why Get The Flu Shot

    Research shows vaccination helps prevent flu. Data analysis from the Centers for Disease Control and Prevention shows that, during the 2019-2020 flu season, vaccinations prevented an estimated 7.5 million flu cases.

    Even if you still get the flu after vaccination, a flu shot lowers your risk of becoming seriously ill. CDC research also found that flu shots prevented 3.7 million influenza-related medical visits, 105,000 flu-related hospitalizations and 6,300 flu-related deaths. Additionally, the CDC cites an independent 2021 study, which found that adults who contracted the flu after receiving their flu vaccines had a 26% lower risk of being admitted to an intensive care unit and a 31% lower risk of death compared with those who didn’t get the shot. Flu shots also lower the risk associated with heart disease, lung disease and diabetes, helping keep people with these conditions from becoming sicker if they get the flu, according to the CDC.

    Along with the benefits a flu shot provides for your own health, it also helps protect others around you including those especially vulnerable to the worst effects of flu, such as young grandchildren, pregnant women and people with chronic illnesses.

    What You Need To Know About The Flu Shot

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    The annual flu vaccine helps prevent the flu. It is safe and effective. The vaccine can help with several strains of the influenza virus. It causes your body to make antibodies. These antibodies help protect your body against infection.

    Many strains of the flu virus exist and can change often.

    The seasonal flu vaccine also changes every year. This is to keep up with the three most common strains of the virus of that year. You need to get a new vaccine every year to stay safe.

    Who should get a flu shot?

    According to the Centers for Disease Control, those most at risk should get the flu shot. This includes:

    • Children younger than 5
    • Anyone with a weakened immune system or chronic condition .

    Getting a flu shot is helpful for two reasons:

    • Prevention: The flu vaccine prevents millions of medical visits and thousands of hospitalizations and deaths each year by protecting the patient and the people around them
    • Reduction of severity: Flu vaccines can reduce the severity of flu illness for people who are vaccinated but still get sick

    Even healthy people should get the shotHealthy people can still carry the flu virus. They can still spread it to others without showing symptoms. You may feel healthy. The shot prepares your body to fight off the flu. It also helps to kick-start your immune system.

    Egg-less flu shots are availableThere is an option for those allergic to eggs. Ask your health care provider or pharmacist if the egg-less alternative is right for you.

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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.

    Are There Any Side Effects Of The Flu Vaccine

    You may experience mild side effects associated with getting a flu shot or a nasal spray flu vaccine, such as soreness, fever, headache or muscle aches. Side effects generally dont last long and tend to be minor when compared to the symptoms of a bad case of flu.

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    The Single Best Way To Prevent The Flu Is To Get Your Flu Shot

    Does medicare cover flu shots at publix. Talk with your doctor about getting your flu shot each year. Because medicare advantage plans must offer at least the same coverage as original medicare, your medicare advantage plan also covers flu. The annual flu vaccine helps prevent the flu.

    The centers for disease control and prevention recommends everyone 6 months and older get the flu. Covers 2 different pneumococcal shots. Publix accepts most major insurance plans.

    The vaccine is available for adults and for children 6 months and older. Medicare part b part b covers certain doctors’ services, outpatient care, medical supplies, and preventive services. A person should note, however, that medicare does not cover the cost of a flu shot from every healthcare practice.

    Some pharmacies offer the fluzone high dose, which is recommended for people age 65 and older. Getting the flu shot protects you from getting the flu and keeps you from spreading it to others. All publix pharmacies offer the traditional flu shots for $30.

    It is safe and effective. Learn more and book an appointment. Flu shots are covered under original medicare and medicare advantage, so long as your provider or pharmacy is one that accepts medicare payment.

    Many strains of the flu virus exist and can change often. Find a flu shot location near you. Flu shots are also offered at certain innetwork chain or independent pharmacies at no additional

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    Whats Included In Medicare Vaccine Coverage

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    Original Medicare covers several common vaccines, but you may need to meet certain eligibility requirements first. For instance:

    • Pneumococcal Vaccine: You can receive the first shot at any time, but inorder to receive a second one, you must get it within one year of the first.
    • HepatitisB Vaccine: Your doctor must determine that youre at a medium or higherrisk in order to receive the Hep B vaccine. Factors that may increase your riskinclude if you live with someone who has the virus, you have diabetes,hemophilia, or End-Stage Renal Disease, or if you work in a health careenvironment and regularly come in contact with bodily fluids.

    You may be able to receive the vaccines covered under Original Medicare at your doctors office or at a nearby pharmacy. You should consult with your healthcare professional ahead of time to ensure that they accept Medicare, and that you meet any necessary eligibility guidelines. Youll typically be able to receive covered vaccines at no additional cost, as long as your healthcare provider accepts Medicares payment terms.

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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.

    When Should I Get The Flu Shot

    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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    Medicare Covers Your 2020 Flu Shot

    Things may be different this flu season, but your flu shot coverage is the same. We know that cost might be a factor when deciding whether to get a flu shot, but heres some good news: youll pay nothing when you get yours from a doctor or other qualified health care provider who accepts assignment.

    How Much Will My Flu Shot Cost

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    Flu shots at designated retail pharmacies and clinics are covered at 100% for most benefit plans. Check your benefit plan details or call the number on your member ID card to be sure youre covered at the flu shot location you choose. Remember to bring your member ID card when you visit network providers for your flu shot.

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    Billing Considerations For Part B Vaccines

    Whether participating or non-participating in Medicare, physicians must accept assignment of the Medicare vaccine payment rate and may not collect payment from the beneficiary for the vaccine.

    Non-participating physicians may choose not to accept assignment on the administration fee. When a non-participating physician or supplier provides the services, the beneficiary is responsible for paying the difference between what the physician or supplier charges and the amount Medicare allows for the administration fee. The limiting charge provision does not apply to the influenza benefit.The influenza and pneumococcal vaccines and the administration of these vaccines are not subject to the Medicare Part B deductible or co-insurance. Medicare pays at 100% of the allowable amounts. However, the Hepatitis B vaccine and administration are subject to the deductible and co-insurance. Medicare pays at 80% after the patient has met their Part B deductible.Medicare will pay two administration fees if a beneficiary receives both the influenza virus and the pneumococcal vaccine on the same day.Claims for the hepatitis B vaccine must include the name and NPI of the ordering physician, as Medicare requires that the hepatitis B vaccine be administered under a physicians order with supervision. This is not necessary for the influenza and pneumococcal vaccines for which Medicare does not require a physician’s order or supervision.

    Medicare Part B: Vaccine Coverage

    Medicare Part B provides preventive coverage only for certain vaccines. These include:

    • Influenza: once per flu season
    • Pneumococcal:
    • Hepatitis B: for persons at intermediate- to high-risk

    Administration services for these preventive vaccines are reported to Medicare using HCPCS codes as follows:

    • G0008 administration of influenza virus vaccine
    • G0009 administration of pneumococcal vaccine
    • G0010 administration of Hepatitis B vaccine

    The diagnosis code to report with these preventive vaccines is:

    • Z23 Encounter for immunization

    Other immunizations are covered under Medicare Part B only if they are directly related to the treatment of an injury or direct exposure Coverage of other vaccines provided as a preventive service may be covered under a patient’s Part D coverage.

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    How To Get Part D Coverage

    You can get Medicare Part D coverage either through a stand-alone Part D Medicare Prescription Drug Plan or through a Medicare Advantage plan that includes prescription drug coverage. Both stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage plans are available from private, Medicare-approved insurance companies. With a stand-alone Medicare Part D Prescription Drug Plan, you will keep your Original Medicare coverage. A Medicare Advantage plan is another way to get you Part A and Part B benefits although you must continue to pay your Part B premium as well as any premium the plan may charge. Hospice benefits are still covered directly under Medicare Part A.

    Would you like to know more about Medicare coverage of vaccines? Id be happy to help you. I can walk you through your options or email you information you can request that using the links below. Or take a look at plans by clicking the Compare Plans buttons on this page.

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    When Should You Get The Influenza Vaccine

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    Annual immunisation is recommended as the influenza virus is constantly changing, and the vaccine changes accordingly.

    Getting vaccinated in autumn is recommended. This provides protection in time for the peak influenza season . However, it is never too late to vaccinate since influenza can circulate in the community all year round.

    Influenza vaccines can be co-administered with a COVID-19 vaccine.

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    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

    If Im Healthy Do I Need A Flu Shot

    Even if youre healthy, a yearly flu shot is recommended by the CDC and AMA. In fact, its recommended for everyone 6 months of age and older. Its one of the best ways to help protect yourself and your family against seasonal flu, according to the CDC.1

    The flu shot has been shown to have many benefits including reducing the risk of flu illnesses, hospitalizations and even the risk of flu-related death in children.3

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    Who Should Get A Flu Shot

    The CDC recommends a yearly flu shot for all adults and children 6 months of age and olderunless 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 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:

    • Asthma or COPD

    Who Is At High Risk For Complications From The Flu

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    According to the CDC, most people who get the flu will only be mildly ill and will recover without medical care in two weeks or less. However, certain people are at a higher risk for serious complications from the flu virus. If any of these apply to you, you may be at higher risk:

    • Individuals under age 2 or age 65 and over
    • Residents of nursing homes or long term care facilities
    • Pregnant women and women who have recently given birth
    • American Indians and Native Alaskans
    • People with certain health conditions including asthma, chronic lung or heart disease, neurological disorders, blood disorders, diabetes, diseases of the liver or kidneys, cancer, HIV/AIDS, weakened immune systems, and extreme obesity with a body mass index of 40 or greater

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