Does Medicare Cover the Cost of Annual Flu Shots?
With all the public attention the COVID vaccine gets, we may be tempted to neglect other preventive services, including the flu shot. Serious illness and hospitalizations resulting from the flu, but getting the annual vaccine can help protect you and your loved ones.
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Are You Wondering if the Flu Shot is Covered by Medicare?
Medicare covers 100% of the cost of one flu shot per season. That’s one flu vaccine every year with the season typically running from the beginning of fall to the end of spring. Additional shots would be covered if deemed medically necessary by your doctor.
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What is the Flu?
The flu, a common term for influenza, is a respiratory condition brought on by viruses that invade the nasal passages, throat and lungs. The flu is a highly contagious illness and can lead to severe complications. The Centers for Disease Control and Prevention (CDC) recommends an annual flu vaccine to avert the serious consequences of the flu.
People most vulnerable to flu complications are adults 65 and older, young children and people with chronic health conditions that lower the immune system. The CDC recommends different types of flu vaccines based on age. The rule of thumb is to get your influenza shot in September or October in preparation for the flu season, which generally prevails from fall through winter.
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Are There Different Types of Flu Shots?
The flu vaccines approved in the U.S. are quadrivalent, meaning they facilitate an immune response against four types of influenza viruses, two influenza A and two influenza B.
A virus created in eggs is the basis of the standard flu shot. The Flucelvax quadrivalent is a cell-based, egg-free vaccine that the CDC recommends for children 6 months and older.
If you are 65 years or older, the CDC suggests one of the following:
- Fluad quadrivalent adjuvanted flu vaccine: an egg-based vaccine with an adjuvant, an ingredient that stimulates a robust immune response
- Flublok quadrivalent recombinant flu vaccine: a vaccine synthetically engineered without the flu virus or eggs, approved for people 18 years and older
- Fluzone high-dose quadrivalent vaccine: a vaccine that contains quadruple the antigen, the substance that mounts protection against the flu, and is U.S.-approved for the 65-plus population exclusively
Medicare Coverage for Vaccinations
Medicare covers various preventive services under Part B (medical insurance). Most Part B services require that you pay the Part B deductible and 20% coinsurance. However, preventive services generally require no out-of-pocket expense if you use a healthcare provider accepting assignment.
When a Medicare-participating provider or supplier accepts assignment, the provider agrees to accept the Medicare-approved amount. This limits your financial responsibility to the deductible, coinsurance and copayments, if applicable. Non-participating providers can elect to accept the Medicare-approved amount on a case-by-case basis.
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Does Medicare Cover Flu Shots?
Your seasonal flu vaccine is one of the Part B preventive services for which you are eligible at no cost if your healthcare practitioner accepts assignment. If medically necessary, Medicare may pay for two shots in a calendar year over two different flu seasons.
For example, January in winter and October the following fall. But, typically, Medicare coverage for flu shots applies to one quadrivalent flu vaccine per season, ideally by the end of October before the flu season begins.
Other vaccines Medicare covers are Hepatitis B, pneumococcal and COVID-19. Medicare also includes an annual Wellness Visit that gives you the opportunity to visit your physician to review your health, discuss any concerns you may have, and create a preventive plan to keep you healthy.
TIP: Learn all you need to know about Medicare coverage for the Shingrix shingles vaccine.
Where Do You Get Your Annual Flu Vaccine?
Your Medicare coverage for flu shots applies whether you get the vaccine at your doctor’s office or a local pharmacy. Some pharmacies offer a wide range of vaccinations, including shots to protect from shingles, COVID-19 and influenza.
You can opt to get multiple vaccines during the same visit but check with your doctor first. The vaccines you receive at the pharmacy, usually administered with a needle in the arm muscle, are no different than what you would get at the doctor’s office.
Does Medicare Cover Flu Shots at CVS?
Many CVS locations offer vaccinations but typically require that you schedule an appointment online. You can also use the CVS app on your phone or tablet. Some locations may accept walk-ins.
Many CVS pharmacies house a MinuteClinic within their pharmacies. In most states, the MinuteClinic vaccinates children from 18 months old. The minimum age for vaccination in the pharmacy is 3 years old.
Does Medicare Cover Flu Shots at Walgreen?
Walgreens is another option for your flu vaccine. Schedule your vaccine appointment online, and bring your Medicare insurance information with you. Walgreens suggests that you complete an assessment and consent form in advance. The company website offers links to print the forms.
Medicare Advantage Vaccine Coverage
Medicare Advantage (Part C) is an alternative to Original Medicare coverage. When you are eligible for Medicare, you can sign up for Parts A and B. You can receive your benefits through Original Medicare, the federal program that administers Part A and Part B coverage, or you can choose to enroll in a Medicare Advantage plan.
Medicare Advantage (MA) plans are offered by private insurance companies. They are required to include the same benefits as Original Medicare, but most MA plans include additional coverage, such as vision and dental care, gym memberships, and Part D prescription drug coverage. Many MA plans offers a way to get your Medicare insurance under an umbrella plan that bundles Parts A, B and D under one policy.
Medicare coverage for flu shots is the same whether you get your benefits through Original Medicare or Medicare Advantage. However, Medicare Advantage plans may have a provider network that you must use to receive full coverage. To ensure you do not have to pay out of pocket, you’ll need to visit providers, pharmacies and hospitals within your plan’s network.
TIP: Discover the top 7 reasons why people choose to switch Medicare Advantage plans.
Why the Influenza Vaccine is Important
The flu is very common and can be spread from person to person, so getting the flu shot protects your family and friends, especially those at higher risk for complications. According to the National Institutes of Health (NIH), influenza is the cause of millions of afflictions globally that lead to thousands of deaths each year.
Symptoms can range from coughing and chills to fever, aches and extreme fatigue. The risk for older adults is greater because immune systems weaken with age.
The top flu symptoms include:
- muscle aches
- sore throat
- chills and sweats
- shortness of breath
- runny or stuffy nose
- dry, persistent cough
People 65 and older and residents of nursing homes and other long-term care facilities run a greater risk of hospitalization, heart attack, stroke and pneumonia. Also, people with chronic health conditions like diabetes, asthma or heart disease are also at high risk of developing complications from the flu.
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