Does Medicare Pay for Flu Shots at a Pharmacy?
Understand how Medicare covers your annual flu shot, including convenient access points and navigating your plan's specific benefits.
The flu is a respiratory illness that can cause mild to severe symptoms. An annual flu shot is an important preventive measure, especially for Medicare-eligible individuals. For those 65 and older, the flu can lead to serious complications, including hospitalization and even death. Medicare helps make these vaccines readily available, ensuring beneficiaries can access this health service.
Flu Shot Coverage Under Medicare Part B
Medicare Part B covers one seasonal flu shot per flu season. This coverage is a preventive service. As a preventive service, the flu shot is covered at 100% of the Medicare-approved amount.
Beneficiaries with Original Medicare Part B pay nothing out-of-pocket for their annual flu shot, meaning there is no copayment, coinsurance, or deductible. Coverage applies to all individuals enrolled in Original Medicare Part B, provided the healthcare provider accepts Medicare assignment. In some instances, if two different flu seasons occur within a single calendar year, Medicare Part B may cover a second flu shot.
Receiving Your Flu Shot at a Pharmacy
Pharmacies offer a convenient and accessible option for receiving your annual flu shot. Many major pharmacy chains across the United States are equipped to administer these vaccinations. This widespread availability allows beneficiaries to get their flu shot close to home or work.
When visiting a pharmacy for a flu shot, Medicare beneficiaries should present their Medicare card. Most pharmacies directly bill Medicare Part B for the service. It is advisable to contact the pharmacy beforehand to confirm they accept Medicare assignment for flu shots and to inquire about any appointment recommendations, though many locations offer walk-in services. Pharmacists or certified immunizers are qualified to administer the vaccine safely in these settings.
Coverage Through Medicare Advantage Plans
Medicare Advantage Plans, also known as Medicare Part C, are legally required to cover all the benefits provided by Original Medicare, including the seasonal flu shot. Individuals enrolled in a Medicare Advantage Plan receive their annual flu shot at no cost, with no deductibles, copayments, or coinsurance for this preventive service. While the flu shot is covered at no additional charge, beneficiaries with a Medicare Advantage Plan should verify their plan’s specific network requirements. Some plans may encourage or require using preferred pharmacies or providers within their network. Checking with the specific Medicare Advantage plan beforehand can help ensure a seamless experience.