Flu season rolls around every year, and flu vaccines are essential to protect yourself from getting sick. Millions of Americans get the flu shot each year, and many of them have insurance that covers the shot. With seniors being at high risk for complications from the flu, it is even more critical that they protect themselves from the flu. The Centers for Disease Control and Prevention (CDC) recommend that those over age 65 get an annual flu shot. Most of these seniors have Medicare coverage, so Medicare coverage for the flu shot is essential to them. You might be wondering whether Medicare covers the flu shot? Keep reading as we give you all the details on getting your flu shot covered with Medicare.
Â
Does Medicare Cover Flu Shots?
Yes, Medicare generally covers your annual flu shot. However, your Medicare coverage details are different depending on which type of Medicare you are enrolled in. As you probably already know, there are many different parts of Medicare. Here are the coverage details for each part.
Â
— Medicare Part A
Medicare Part A does not cover the flu shot. Remember that Medicare Part A is hospital insurance. This provides coverage for inpatient services, hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part A does not provide coverage for vaccines, such as the flu shot. If you are only enrolled in Medicare Part A, then you will need to pay out-of-pocket for your flu shot.
Â
Medicare Part B
Medicare Part B covers your flu shot each flu season at 100%. Remember that Medicare Part B is medical insurance that covers doctor visits, preventive services, durable medical equipment, and many vaccines. It also covers mental health treatments and most outpatient care. Medicare Part B is optional, and it also includes an annual deductible that must be met. Most services are covered at 80%, although the flu vaccine and many preventive services are covered at 100%.
Â
— Medicare Advantage Plans
A Medicare Advantage plan, or Medicare Part C, is a way to combine all your Original Medicare coverage together into a single plan. This includes Part A, Part B, and Part D prescription drug coverage. These plans are managed by private insurance companies, so the coverage details vary from plan to plan. Part C plans must provide at least the same minimum level of coverage provided by Original Medicare. Advantage plans cover the flu shot at 100%, although you should check your plan details for coverage specifics. Most of these plans include coinsurance or copayments for other services.
Â
— Medicare Part D
Part D prescription drug plans will typically cover immunizations and other vaccines, like the flu vaccine. However, enrollment in a Part D plan requires that you be enrolled in Part B coverage. Since you are already enrolled in Medicare Part B, your Part B health insurance will cover the cost of your flu shot. Simply make sure that your healthcare provider will accept Medicare, and you should not have to pay anything for your flu vaccine.
Â
How Often Will Medicare Pay For A Flu Shot?
So, how often will a flu shot be covered by Medicare? According to Medicare.gov, Medicare will cover one flu shot per flu season. Some preventive services are only covered once per year or once every rolling 12 months. However, that is not the case with the flu shot. Depending on how you schedule your shots, you might receive two shots within the same calendar year and have Medicare cover them both. Consider the following example.
Imagine that you received your flu shot in January 2022 for the 2021-2022 flu season. Although this is a little late in the season, the shot would be covered by Medicare. Perhaps you decide to get your shot earlier in the season next time. So, you might decide to receive your shot in November 2022 for the 2022-2023 flu season. This would have you receiving two flu shots in 2022 – one in January and one in November. However, those shots are for two different flu seasons. Therefore, Medicare would cover them both even though they were received within the same calendar year.
Â
Cost Of A Flu Shot With Medicare
As long as your doctor’s office or other healthcare provider agrees to accept Medicare assignment for the flu shot, it will not cost you anything to receive your shot with Medicare. The shot will be covered at 100%, and it will not cost you anything out-of-pocket. Many seniors choose to simply visit their local CVS or Walgreens pharmacy to receive their shot instead of going to the doctor’s office. Eligibility for this coverage only requires that you be enrolled in Medicare Part B or a Medicare Advantage plan. The Medicare program will cover the full cost of your flu vaccine once per flu season.
If you don’t have a Medicare plan or other insurance plan that covers your seasonal flu shot, your cost will vary. The type of shot you receive will affect the price, but most flu shots cost between $25 and $75 without insurance. Medicare Supplement insurance, or Medigap, is not likely to help you much either. Since you must be enrolled in Original Medicare to purchase Medigap, your shot would already be covered 100% in that case.
Â
Does Medicare Pay For Other Vaccines?
Yes, Medicare pays for many other important vaccines besides the flu vaccine. One of the most important ones at the current time is the COVID-19 vaccine. Medicare fully covers the COVID vaccine as well as COVID boosters. Medicare Part B covers the flu vaccine and COVID vaccines, along with the pneumococcal vaccine. In some cases, it even covers the Hepatitis B vaccine for those with certain health conditions.
Many Part D plans provide additional coverage for even more vaccines. Some plans cover the shingles vaccine, tetanus shots, and others. If you need to enroll in a Part D plan, you should speak to a licensed insurance agent in your local area. They can help you identify the plans that are available in your area, and they can walk through coverage details to help you select the plan that best fits your needs.
Â
The Bottom Line
Medicare Part B covers one flu vaccine during each flu season. This means that you could even receive two flu shots during the same calendar year, as long as each shot was obtained in a different flu season. In addition to the flu shot, Medicare provides coverage for many other important vaccines, like the COVID-19 vaccine. If you have a Medicare Advantage plan, then you also receive this coverage. Your Medicare Part D plan or Medicare Advantage plan might also provide coverage for even more vaccines and preventive services.
Â
Frequently Asked Questions
Â
Does Medicare cover flu shots at 100%?
Yes, Medicare Part B covers flu shots at 100%. While there is typically a coinsurance amount associated with Part B coverage, the flu shot is covered at 100%. Your Medicare Advantage plan should also cover this shot at 100%. When it comes to other vaccines, you might be required to pay a copay or coinsurance amount at the time of treatment. Coverage for other vaccines depends on the specifics of your plan.
Â
How much does the flu shot cost without insurance?
The cost of the flu shot without insurance depends on the type of shot you receive and the provider. In most cases, the shot ranges from $20 to $75. The high-dose flu shot is on the higher end of the scale. It typically costs $50 to $75. Those individuals in the high-risk category often need to receive a high dose to help further decrease their odds of contracting the flu.
Â
Is there a Medicare deductible for the flu shot?
No, there is no deductible associated with the flu shot. The shot is covered at 100%, and you are not required to meet your deductible or pay a coinsurance amount. Most Part B services require your Part B deductible to be met, but the flu shot is an exception. You can receive your shot with no out-of-pocket cost required.
