Are RSV Vaccines Covered by Medicare?
Demystify Medicare's coverage of the RSV vaccine. Learn about costs, eligibility, and how to access your vaccination.
The Respiratory Syncytial Virus (RSV) vaccine is a significant advancement in preventive healthcare, particularly for older adults. This article explains the coverage details under Medicare, helping individuals navigate the process of obtaining their RSV vaccination.
Medicare Parts and Vaccine Coverage
Medicare is structured into various parts, each covering different healthcare services. Original Medicare includes Part A (Hospital Insurance) and Part B (Medical Insurance). Part A generally covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services, including some vaccines.
For vaccines, Part B specifically covers influenza (flu) shots, pneumococcal (pneumonia) vaccines, Hepatitis B shots for individuals at medium or high risk, and COVID-19 vaccines. These vaccines are typically covered at no cost to the beneficiary if the provider accepts Medicare assignment, meaning no deductibles or copayments apply for these specific immunizations.
Most other adult vaccines recommended by the Centers for Disease Control and Prevention (CDC) are covered under Medicare Part D, which is prescription drug coverage. Part D plans are offered by private insurance companies approved by Medicare, and they can be stand-alone plans or part of a Medicare Advantage (Part C) plan. Medicare Advantage plans, also known as Part C, are offered by private companies and include all the benefits of Original Medicare (Parts A and B), often with additional benefits like prescription drug coverage.
RSV Vaccine Coverage Details
The RSV vaccine is covered by Medicare, primarily through Medicare Part D. Recent legislation, specifically the Inflation Reduction Act of 2022, brought about significant changes, making all adult vaccines recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP) available with no out-of-pocket costs under Part D. This means that for eligible individuals with Part D coverage, there should be no copayments or deductibles for the RSV vaccine.
Eligibility for the RSV vaccine under Medicare generally aligns with CDC recommendations. The CDC recommends the RSV vaccine for all adults aged 75 years and older, and for adults aged 60 to 74 years who have increased risk factors for severe RSV disease. Risk factors can include chronic heart or lung disease, weakened immune systems, or certain other medical conditions.
Original Medicare Parts A and B do not cover the RSV vaccine directly. Coverage for the RSV vaccine falls under the prescription drug benefit of Medicare Part D. Therefore, to receive coverage for the RSV vaccine, individuals must be enrolled in a Medicare Part D plan, either as a stand-alone plan or as part of a Medicare Advantage plan that includes prescription drug coverage.
Costs and How to Get Your Vaccine
For individuals with Medicare Part D coverage, the RSV vaccine should generally be available at no out-of-pocket cost. This includes the cost of the vaccine itself and any administration fees. The elimination of cost-sharing for ACIP-recommended vaccines under Part D means beneficiaries do not face deductibles, copayments, or coinsurance for this immunization.
While the vaccine itself is free at the point of service for Part D enrollees, individuals are still responsible for their monthly Part D plan premium. These premiums vary depending on the specific plan chosen, with the national base beneficiary premium for Part D being $36.78 in 2025. Those without Part D coverage might face out-of-pocket costs ranging from approximately $180 to $295, or even up to $550, for the vaccine.
Individuals can typically receive the RSV vaccine at various locations, including their doctor’s office or a local pharmacy. When planning to get vaccinated, it is advisable to contact the pharmacy or healthcare provider beforehand to confirm they stock the RSV vaccine and accept Medicare. Beneficiaries should bring their Medicare card and any other insurance details to the appointment to ensure proper billing and coverage.