Does Medicare Cover the Cost of the RSV Vaccine?
Clarify Medicare's coverage of the RSV vaccine. Understand your benefits, potential costs, and how to get your shot.
Respiratory Syncytial Virus (RSV) is a common respiratory virus that typically causes mild to moderate cold-like symptoms. However, for older adults, RSV can lead to more severe conditions, including pneumonia and bronchitis. The RSV vaccine offers a way to protect eligible individuals from these serious health complications.
Medicare Coverage for RSV Vaccine
Medicare provides coverage for the RSV vaccine for eligible beneficiaries. For most individuals enrolled in Medicare, the RSV vaccine is covered under Medicare Part D, which encompasses prescription drug plans. This coverage extends to all adult vaccines recommended by the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP).
Original Medicare, specifically Part A (Hospital Insurance) and Part B (Medical Insurance), generally does not cover the RSV vaccine. However, Medicare Advantage Plans, also known as Part C, are required to cover at least the same benefits as Original Medicare. If a Medicare Advantage Plan includes prescription drug coverage, it will also cover the RSV vaccine.
The Inflation Reduction Act of 2022 eliminated out-of-pocket expenses for all ACIP-recommended adult vaccines covered under Medicare Part D, effective January 1, 2023. The RSV vaccine falls under this provision.
Understanding Your Costs for the Vaccine
For Medicare beneficiaries with Part D coverage, the RSV vaccine typically comes with no out-of-pocket costs. This means individuals should not incur expenses for deductibles, copayments, or coinsurance specifically for the vaccine itself.
While the vaccine cost without insurance can range between approximately $250 and $550, Medicare Part D covers this expense. Beneficiaries should remember that while the vaccine itself has no cost-sharing, they will still be responsible for their monthly premium for their Medicare Part D plan or Medicare Advantage Plan. The specific premium amount can vary depending on the chosen plan.
How to Get Your RSV Vaccine
Medicare beneficiaries can obtain the RSV vaccine at various convenient locations. Common sites for vaccination include local pharmacies and a physician’s office. It is often advisable to schedule an appointment to ensure the vaccine is available and to minimize wait times.
When seeking the vaccine, individuals should bring their Medicare identification. Before receiving the vaccine, it is beneficial to confirm with the provider that they accept Medicare and are equipped to bill for the vaccine correctly under your specific plan.