Does Medicare Cover Flu Shots? Price and Coverage

To protect your health in the winter and fall months, flu shots are necessary.

Flu season usually begins in November and continues through April. The peak season for flu cases is between December and February. It was rare for the 2018-2019 flu season to last until May. Influenza, also known as the flu, can cause fever, sore throats, headaches and fatigue.

The flu can be dangerous and even life-threatening for those 65+ According to the Centers for Disease Control and Prevention ( CDC), this population is at highest risk for complications of the flu. These can cause hospitalizations and even lead to death. In 2018, the flu season saw 42.9 million people get sick, 647,000 were admitted to hospital, and 61,200 die. According to a study published by CDC in 2019,, ninety percent of flu-related hospitalizations occurred among people older than 65.

According to the CDC, getting an annual flu shot is the best way to avoid seasonal flu and its complications. While some people may still be ill after receiving the flu vaccine, there was a 2018 study that found those who got the flu shot had less severe symptoms and were less likely to need hospitalization.

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“For people over 65 and those who have major medical conditions such as diabetes or asthma or are living in a nursing facility, doctors should be notified if they experience flu symptoms such as fever, chills or headaches,” states Ishaniganguli, an assistant professor at Harvard Medical School. It is important to seek medical attention for severe symptoms such as fever exceeding 104 degrees, trouble breathing, or confusion.

Does Medicare Cover Flu Shots?

Medicare coverage is available to anyone 65 years of age or older. Medicare also covers flu shots. Not all Medicare programs include free flu shot coverage. Medicare Part B (Medicare Advantage plans) covers the entire cost of flu shots if you visit a pharmacy that accepts Medicare payments. Call ahead to confirm that they accept Medicare assignments before you visit a new healthcare provider.

How do I get Medicare coverage for flu shots

According to the Centers for Medicare & Medicaid Services, there are many parts of Medicare. It is important to understand what each part covers, and which is the most beneficial for you.

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Medicare Part B covers hospital stays, but not the flu shot

Medicare Part A includes hospitalizations, skilled nursing facilities and hospice care. The flu shot is not covered by Medicare Part A.

Eligible people 65 years and older can get it for free. This portion of Medicare is generally free if your spouse has paid Medicare taxes for at minimum 10 years. This can be signed up starting three months prior to your 65th birthday. You are automatically enrolled in Part B if you were receiving social security benefits prior to your 65th birthday. You will need to register online or in person for Part A.

Medicare Part A covers preventive services, such as flu shots

Medicare Part B is your insurance policy for medical care. It covers preventive services such as the flu shot. Medicare covers one flu shot per season, but it may pay for a second if medically necessary. Medicare coverage covers flu shots approved by the United States Food and Drug Administration for those over 65.

Because they have not been approved by the FDA for this age group, Medicare doesn’t cover nasal spray flu vaccines.

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Medicare Part B also covers a seasonal influenza vaccine H1N1, a pneumococcal vaccination, and hepatitis B shots if an individual is high-risk.

If they are related to injury or illness treatment, Part B includes certain shots. If your doctor treats an injured patient with a tetanus injection, for example.

Part B is optional. Some people with employer insurance (either through their spouse or themselves) might choose to keep their insurance and sign up later for Part B. This can be signed up during your initial enrollment period in the same way as Part A. It is also possible to sign up for it up to eight months after your last work day or if you lose your insurance coverage. You might have to pay late enrollment penalties if you do not sign up for Part A, even if you are eligible.

Medicare Part B includes Parts A, B–flu shot

Medicare Part C plans offer both Part A benefits and Part B benefits. Part B benefits are included in Medicare Part C, which covers flu shots. Part C plans may also offer prescription drug coverage. This is generally covered under Medicare Part D.

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Medicare Part A covers prescriptions and any other vaccines that you might need

Medicare Part D, an optional prescription drug plan, is available. There are many options for plans, including copayments, coinsurance and deductibles. These plans also cover flu shots, if they are medically necessary and reasonable. The following are common vaccines that Part D covers:

  • All Part D plans must include the Shingles vaccine. Two types of FDA-approved Shingrix (recombinant virus) shingles vaccines have been approved by the FDA: Zostavax (zoster), and Shingrix. The preferred Shingrix vaccine is available since 2017.
  • Tdap vaccine to prevent tetanus and diphtheria (also known as whooping cough).
  • MMR (measles mumps and rubella) vaccine
  • BCG vaccine against tuberculosis
  • Meningococcal vaccinations
  • Hepatitis A, Hepatitis B vaccinations for those considered high-risk

The cost of your vaccine will vary depending on where it is given. Gail Trauco (RN, BSN,OCN), a patient advocate and founder Medical Bill 911, says that it is important to review your insurance coverage and find the best place to get your vaccine. “Typically, you’ll pay less for your vaccines at in-network pharmacies and at doctors who coordinate with pharmacies to bill your PartD plan for the drug.

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For more information about Medicare, contact a licensed agent or inquire at a Social Security office. While Part A is available for free to all who are eligible, you’ll need to pay a monthly premium for parts B, C and D.

Private companies also offer Medicare supplement insurance plans called Medigap coverage. These plans can be used in conjunction with your Original Medicare (Part A, B), and may help to pay copayments or coinsurance. There are many Medicare supplement plans available. It is important to choose the right one for you. A specialist in seniors insurance can give you information about the different plans.

Seniors get flu shots at no cost.

Seniors who have Medicare Part A or C are eligible for one free flu shot each year. However, there are some seniors who do not have Medicare Part B or C and may need to pay out-of-pocket for flu shots.

Depending on the pharmacy, Fluad and Fluzone High-Dose may cost between $139 and $160 without Medicare, Medicaid or any other type of health insurance. For as little as $70, some pharmacies offer flu shots for seniors. To find out if your area offers free flu shots to those without insurance, you can contact your county health department or senior center.

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SingleCare coupons can be used to get discounts on your order. SingleCare offers coupons for Fluzone High-Dose and Fluzone Low-Dose.