Does Medicare cover the RSV vaccine?

Respiratory syncytial virus (RSV) is a respiratory virus that causes mild, cold-like symptoms. RSV infections can be more dangerous for certain adults, but just 1 dose of the RSV vaccine can help protect adults aged 60 and older from getting very sick.1

Here are some details about RSV, what parts of Medicare cover the vaccine and more.

What is RSV?

Most people with common symptoms can recover in 1–2 weeks. However, RSV can cause severe symptoms in older adults and adults with certain underlying conditions.2

Common RSV symptoms

Some mild symptoms of RSV include:

  • Fever
  • Headache
  • Runny nose
  • Cough
  • Sore throat

Serious RSV symptoms

RSV can sometimes cause or worsen serious conditions like:

  • Pneumonia
  • Asthma
  • Congestive heart failure (CHF)
  • Chronic obstructive pulmonary disease (COPD)

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Who has the highest risk for severe RSV infection?

Older adults have the highest risk for severe infection. In addition to age, these conditions and situations can increase the chance of a severe infection:1

  • Chronic heart or lung disease
  • Weakened immune systems
  • Other underlying medical conditions
  • Living in a nursing home or long-term care facility

Which parts of Medicare will cover the RSV vaccine

Original Medicare Part A (Hospital insurance) and Part B (Medical insurance) do not cover the RSV vaccine.

Medicare Part D (Prescription drug coverage) covers the RSV shot and all vaccines that the Advisory Committee on Immunization Practices (ACIP) recommends. People with Part D usually pay nothing out of pocket for most vaccines, including the RSV shot.3

You can join a standalone Part D plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan (Part C) with drug coverage. This type of plan is called a Medicare Advantage prescription drug plan (MAPD). For more information, explore the differences between MAPD and Part D plans.


Is the RSV vaccine free for seniors?

No. In 2024, the out-of-pocket cost for an RSV vaccine can range from $175–$395.4

However, if you have a private health plan, you may pay nothing out of pocket. Check your plan for coverage details.
 

Protect yourself and others against RSV

In addition to getting the RSV vaccine, here are some tips to protect yourself and avoid spreading RSV to others:

  • Wash or sanitize your hands often
  • Keep your hands away from your face, nose and mouth
  • Clean and disinfect surfaces around you
  • Avoid close contact with sick people
  • Cover your coughs and sneezes

Frequently asked questions

1. Does Medicare Advantage cover the RSV vaccine?

No. Medicare Advantage plans do not cover vaccines. However, if you get a Medicare Advantage prescription drug plan (MAPD), the RSV vaccine may be covered.

2. What other vaccines does Medicare cover?

Medicare Part D covers all vaccines recommended by ACIP, including shingles, influenza and more.

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Sources

  1. “RSV in Older Adults and Adults with Chronic Medical Conditions,” CDC.gov, last accessed Aug. 22, 2024.
  2. “Respiratory Syncytial Virus Infection (RSV),” CDC.gov, last accessed Aug. 22, 2024.
  3. “Respiratory Syncytial Virus (RSV) Shot,” Medicare.gov, last accessed Aug. 22, 2024.
  4. “Current CDC Vaccine Price List,” CDC.gov, last accessed Aug. 22, 2024.