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 you can use the Insurify Medicare comparison tool to find the right Medicare plan for you? Start with your ZIP code, and you’ll be comparing plans in less than two minutes. Try it today!
Why Vaccines Matter
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 flu-related hospitalizations occurred in people over the age of 65.
Benefits of the Flu Vaccine
Immunization is invaluable. Here’s why the CDC says the influenza vaccine is your best shot at staying healthy:
- Flu shots prevent the flu. (According to the CDC, in 2018–2019, vaccination prevented 4.4 million cases of the flu.)
- Flu shots reduce the risk of flu-related hospitalization.
- Flu shots lessen the severity of symptoms if you become infected despite vaccination.
If you are over 65 and experiencing flu-related symptoms, seek medical advice from your doctor. Symptoms include fever, chill, headache, or body aches. This can be life-threatening if you have asthma, diabetes, or a weakened immune system.
Your Vaccination Options
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.
Is the High-Dose Flu Vaccine Better for Me?
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.
Medicare Basics: What Are the Different Parts of Medicare?
There are five parts to Medicare. Each part serves a different function or serves a function differently. Some parts work together, and some parts cannot.
Medicare Part A
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.
Medicare Part B
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
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
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
- Meningococcal vaccines
- 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.
FAQ: Medicare and the Flu Vaccine
Is the flu vaccine Free with Medicare?
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.
Do I need the pneumococcal vaccine?
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.
Where can I get a flu vaccine?
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.
Will Medicare cover my flu shot at Walgreens or CVS?
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.
How much does Medicare pay for a flu shot?
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.
How much will a flu shot cost without Medicare?
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.”
Conclusion: Vaccination Is the Goal
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!