How Does Medicare Cover Flu Vaccines?
Vaccine coverage depends on how you’ve set up your Medicare health plan.
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.
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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.
Learn More: Can Medigap Plan G Save You Money?