Updated October 29, 2021
Reading time: 4 minutes
The Flu is Back in Town.
Flu season typically runs from November through April. Flu virus symptoms include fever, fatigue, body aches, cough, and sore throat. Those over 65 are at the highest risk of experiencing flu complications. The best way to prevent seasonal flu (also known as “influenza”) is by getting an annual flu shot.
Now is the time to research your health plan. Does Medicare cover the flu shot, and are there deductibles or co-pays? In this article, we will cover everything you need to know about getting a flu shot when you have Medicare. Let’s get started.
Did you know that the Insurify Medicare comparison tool can help you get better healthcare? Enter your ZIP code to uncover the best Medicare plans near you. Try it today!
Flu vaccines protect you and the people around you. Even people in good health can be hospitalized or die from the flu. With Covid-19 already a global concern, we all need to do our part to keep one another safe.
If you’re over 65 or suffer from upper-respiratory illness, you’re at an increased risk. Flu-related complications send more than 200,000 people in the United States to the hospital each year! In the 2018–2019 flu season, 42.9 million people got sick. Of those, 647,000 people were hospitalized as a result, and 61,200 died.
According to a 2019 study co-authored by the CDC, 90 percent of people hospitalized by flu-related sickness were over 65.
Immunization protects you and your community.
Flu shots prevent the flu— 4.4 million cases of the flu in 2018-19.*
Flu shots lessen the severity of symptoms if you become infected — meaning you’re less likely to be hospitalized.
Flu shots offer important protections to people with chronic illness — including chronic lung disease, COPD, and chronic heart disease.
Flu shots protect people who cannot take vaccinations — fewer infections mean better protection for the most vulnerable.
* According to the CDC
There are several versions of the flu vaccine. The standard flu vaccine is administered via a needle and usually contains three to four dead or inactive strains of the flu. Which strains depend on research: every year researchers identify strains they believe will be most prevalent for that year’s flu season.
If you’re eligible for Medicare, you’re also eligible for a high-dose flu shot (Fluzone High-Dose Quadrivalent). The idea behind the high-dose flu shot is to give those over 65 a boosted immune response, improving protection against seasonal flu.
According to the Centers for Disease Control and Prevention, yes. Studies have shown that Fluzone High-Dose offers better protection than standard-dose flu shots. Adults 65 and older who received the high-dose flu shot had 24 percent fewer flu infections! But the CDC has no preference for either high-dose or standard. The priority is to get vaccinated, period.
Vaccine coverage depends on how you’ve set up your Medicare health plan.
One half of Original Medicare, Medicare Part A covers hospital stays, home healthcare, hospice, and skilled nursing facilities. It does not cover the flu shot. You’re eligible if you are 65 or older, and it’s free if you or your spouse paid Medicare taxes for 10 years or more. You can sign up three months prior to your 65th birthday, either online or at a social security office.
This is the other half of Original Medicare, meant to cover your medical insurance. Medicare Part B covers preventative services like the flu shot. Medicare Part B covers one flu shot a year. A second shot may be covered if medically necessary.
The flu shots covered by Medicare must be FDA approved. This means that nasal spray vaccines are not covered. Other preventative vaccines, such as the seasonal H1N1 swine flu vaccine and hepatitis B shots, are covered if you are in a high-risk category.
You will need to sign up separately for Medicare Part B. Sign up during your Initial Enrollment Period, just as you would with Part A. If you choose to postpone enrollment, be sure to contact a Medicare representative to ensure you post-pone enrollment properly. Postponing enrollment improperly will result in late enrollment penalties that last your lifetime!
Medicare Part C plans offer both Part A and B benefits. Flu shots are covered by Medicare Part C with Part B benefits included. Some Medicare Part C plans include prescription drug coverage. Normally, prescription drug coverage is a part of Medicare Part D.
Medicare Part D is your optional prescription drug plan. Medicare Part D plans have different deductibles, coinsurance, and co-pays. Medicare Part D covers vaccines other than the flu shot when medically required.
Vaccines covered under Part D include:
MMR (measles, mumps, rubella) vaccine
BCG vaccine for tuberculosis
Tdap vaccine for pertussis (whooping cough), diphtheria, and tetanus
Hepatitis A and B vaccines for high-risk individuals
Shingles vaccine: Part D is required to cover the shingles vaccine. The FDA has approved two types: Zostavax (zoster) and Shingrix (recombinant zoster). The preferred vaccine is Shingrix and has been available since 2017.
Private insurance companies offer Medicare Supplement Insurance plans. Also known as Medigap, these plans work alongside your Original Medicare. Medigap may help pay coinsurance and co-pays. There are many different options, so it’s important to determine the right plan for you. Using the Insurify Medicare plan comparison tool is an easy way to find and compare what’s available in your area.
You’re eligible for Medicare if you are 65 or older. There are several different types of Medicare. Check with your healthcare provider or pharmacy before you go. While Medicare covers flu shots, not every Medicare program allows for free flu shots. Medicare Advantage plans (Medicare Part C) and Medicare Part B pay the full cost of the flu shot at any pharmacy or healthcare provider that accepts Medicare. If it’s your first time using a particular pharmacy or healthcare provider, give them a call to ask whether they take Medicare. Inquire about co-payments and reimbursement, and visit medicare.gov to research your Medicare coverage.
The Centers for Disease Control and Prevention recommends pneumococcal vaccination for all adults age 65 and older. There are two kinds of pneumococcal vaccines: Prevnar 13 and Pneumovax23. Both help protect against the pneumococcal bacteria that tends to cause serious infections in senior citizens. Talk with your doctor about which vaccine is right for you.
You can get a flu vaccine at your doctor’s office or local urgent care. If you are in the United States, most pharmacies, such as CVS and Walgreens, offer flu shots as well. If you are having difficulty locating a vaccine provider, visit the CDC website to utilize their free vaccine finder.
The amount you pay for a flu shot varies depending on where you are vaccinated. Most pharmacies, including CVS and Walgreens, accept Original Medicare and Medicare Advantage assignment. The best way to be sure is to contact your local Walgreens or CVS directly. Check your plan’s coverage rules to find out where you can get your vaccine at the lowest cost. Ask questions about deductibles, co-payment, or coinsurance.
The amount Medicare pays for a flu shot depends on the flu shot being administered. The fee Medicare pays for a standard dose vaccine is approximately $30. For the high-dose vaccine, Medicare pays around $60.
Without Medicare, Medicaid, or other health insurance, your annual flu shot can cost anywhere from $30 to $70 or more for the high-dose flu shot. Ask your local senior center or health department if there are locations in your area offering free flu shots. Discounted price coupons for this preventative service are also available from SingleCare. Download the app or visit the website and search “Fluad” or “Fluzone High-Dose.”
Flu shots are effective, extra important for seniors and those in high-risk categories, and with most Medicare health insurance plans, free. Check with your Medicare plan and your local Walgreens or CVS to make sure you’re covered. Ask questions about reimbursement, co-payment, and coinsurance. Take advantage of online coupons and local resources for free and discounted flu shots. Let’s all stay healthy!
And don’t forget that the Insurify Medicare comparison tool is always here to help you find the best Medicare plan at the best price. With just your ZIP code, you can uncover plan options and compare them side-by-side. Try it today!
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Jackie Cohen is an editorial manager at Insurify specializing in property & casualty insurance educational content. She has years of experience analyzing insurance trends and helping consumers better understand their insurance coverage to make informed decisions about their finances.
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