Time to get ready for flu season! You can help protect yourself and your loved ones by getting your flu shot. One of our most commonly asked questions about Medicare is whether the flu shot is covered. Find out how you can get this service at no additional cost.

Everything you need to know about getting your flu shot with Medicare

If you’re eligible for Medicare and have Medicare Part B or C — then yes, Medicare pays for your flu shot as a preventive service. Your flu shot is covered by your Medicare B benefit, which, apart from some other preventive services, also helps cover doctor visits and various outpatient visits. The cost of 1 flu shot each flu season is covered under Part B under both Original Medicare and a Medicare Advantage plan, if you have one.

Find out how Medicare pays for flu shots

Medicare is defined in 4 parts: A, B, C and D. The combinations of Medicare Parts A and B is known as the Original Medicare program. Medicare Part C is known as Medicare Advantage. Whether you’re enrolled in the Original Medicare program or a Medicare Advantage plan, know that your flu shot is covered by Medicare.* The information below provides details about how Medicare covers the flu vaccine depending on the type of Medicare program you’re enrolled in.

*The cost of the shot may be affected if the provider is out of your network.

Enrolled in an Original Medicare plan? Discover how your flu shot is covered.

Original Medicare is commonly known as “traditional Medicare” and is made up of 2 parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). This program is offered by the federal government and provides members with a flu shot without a deductible or copay. The flu vaccine must be given by a physician, pharmacist or healthcare provider who accepts Medicare. This means the healthcare provider has agreed to provide this service and accept payment from the Medicare program/plan at a set rate. It is best to call ahead to find out if Medicare pays for flu shots at your pharmacy.

Got a Medicare Advantage plan? Find out how your flu shot is covered.

The Medicare Advantage plan is also known as Medicare Part C and includes Medicare Parts A and B. This plan is administered by private insurance companies that are required to cover medically necessary services covered by Original Medicare, which includes providing flu shots at no additional cost. However, please know that you will most likely have to get your flu shot from a doctor or healthcare provider that is in your plan’s provider network to receive this service for free.

Breaking down the 4 parts of Medicare: A, B, C and D

Medicare Part A: This part of Medicare helps cover hospital care, skilled nursing facility care, hospice care, home healthcare and nursing home care.

Medicare Part B: This part of Medicare helps cover medically necessary doctors' services, outpatient care, medically necessary chiropractic care, home health services, durable medical equipment (DME) and many other preventive services.

Medicare Part C: This part of Medicare has the same coverage, benefits and rights as Original Medicare but the plans are administered by private insurance companies.

Medicare Part D: This is coverage for prescription drugs that is administered by private insurance companies. Please know that you should check and compare plans each year based on your needs—plan premiums, deductibles, coinsurance, copays and the drugs that are covered will vary each year.

Do you need a flu shot this year?

According to the Centers for Disease Control and Prevention (CDC), people over the age of 65 are at a very high risk of developing dangerous complications from the flu.1 If you are over 65 years old and/or have autoimmune issues (like diabetes or asthma), getting your Medicare-covered flu vaccine is your best defense at protecting you from the flu or lessening the effects of it.

Why is getting your flu shot so important?

It is important to get your annual flu shot for many reasons. First and foremost is that the flu vaccine can help prevent you from getting the flu. Second, according to the CDC, vaccinated people are less likely to go to the doctor for the flu2 and also have a reduced risk of hospitalization with the flu—by 33% in adults age 65 and older.3 The flu shot can also help protect or reduce the effect of flu symptoms in people with chronic health issues related to heart disease,2 as well as people who have diabetes.3

Sources

  1. “Vaccine Effectiveness Studies,” Centers for Disease Control and Prevention, last accessed June 6, 2020, www.cdc.gov/flu/prevent/actions-prevent-flu.htm, opens new window.
  2. “CDC Seasonal Flu Vaccine Effectiveness Studies,” Centers for Disease Control and Prevention, last accessed June 6, 2020, www.cdc.gov/flu/vaccines-work/effectiveness-studies.htm, opens new window.
  3. “Vaccine Effectiveness: How Well Do the Flu Vaccines Work?,” Centers for Disease Control and Prevention, last accessed June 6, 2020, www.cdc.gov/flu/vaccines-work/vaccineeffect.htm#refelderly, opens new window.
  4. J. A. Udell et al., “Association Between Influenza Vaccination and Cardiovascular Outcomes in High-Risk Patients: A Meta-Analysis,” JAMA 23, No. 310(16) (October 2013): 1711–20, accessed June 6, 2020, doi:10.1001/jama.2013.279206.
  5. A. Colquhoun et al., “Effectiveness of Influenza Vaccine in Reducing Hospital Admissions in People with Diabetes,” Epidemiology and Infection 119, no. 3 (December 1997): 335–41, accessed June 6, 2020, doi:10.1017/s095026889700825x.

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