Is the Flu Shot Covered by Medicare?
Navigate Medicare's comprehensive coverage for your flu shot and other key vaccinations. Ensure your preventive health is supported with clear information.
Medicare provides coverage for the annual flu vaccination. This helps protect beneficiaries from seasonal influenza and its potential complications. This coverage encourages vaccination, especially among older adults who may face higher risks.
Medicare Part B Coverage
Medicare Part B, which serves as medical insurance, covers the seasonal flu shot. Beneficiaries typically pay nothing out-of-pocket for this vaccine, meaning there are no deductibles, copayments, or coinsurance. This full coverage applies as long as the healthcare provider or pharmacy administering the shot accepts Medicare assignment.
“Accepts assignment” means the provider agrees to accept the Medicare-approved amount as full payment. They bill Medicare directly and cannot charge the beneficiary more. If a provider does not accept assignment, they may charge additional fees for their services, which could result in out-of-pocket costs for the beneficiary, though Medicare still covers the vaccine itself.
Medicare Advantage Plan Coverage
Medicare Advantage Plans, also known as Medicare Part C, are offered by private insurance companies approved by Medicare. These plans are required to provide at least the same benefits as Original Medicare, including the annual flu shot. Your flu shot is covered at no additional cost.
Individuals with Medicare Advantage Plans should verify their plan’s specific network requirements. Some plans may require beneficiaries to receive their flu shot from an in-network provider for full coverage. Checking with the plan provider beforehand can help avoid unexpected charges.
Accessing Your Flu Shot
Medicare beneficiaries have several convenient options for receiving their annual flu shot. Common locations include a primary care physician’s office, local pharmacies, and community health clinics. Urgent care centers and mass vaccination clinics may also offer the flu shot.
Medicare covers one shot per flu season. The flu season typically runs from November through April, but shots can be available as early as August. Medicare may cover two flu shots within a single calendar year if they fall into different flu seasons.
Other Important Vaccinations
Beyond the flu shot, Medicare also covers other vaccinations. Medicare Part B covers the pneumonia vaccine, typically at no cost to the beneficiary. This vaccine helps protect against pneumococcal disease.
The shingles vaccine, known as Shingrix, is covered under Medicare Part D, which is Medicare’s prescription drug coverage. Original Medicare Parts A and B do not cover the shingles vaccine. Part D eliminated out-of-pocket costs for recommended adult vaccines, meaning beneficiaries pay nothing for the shingles vaccine.