Is the RSV Vaccination Covered by Medicare?

Respiratory Syncytial Virus (RSV) can cause serious illness in older adults. Understanding how Medicare addresses this preventive measure is a common concern for beneficiaries. This article clarifies Medicare’s role in covering the RSV vaccination, including coverage specifics, access points, and financial aspects.

Medicare Coverage for RSV Vaccination

The RSV vaccination is generally covered for eligible Medicare beneficiaries. Original Medicare Parts A and B do not cover the RSV vaccine directly. Instead, coverage is primarily provided through Medicare Part D prescription drug plans, including standalone Part D plans and Medicare Advantage Plans (Part C) that incorporate prescription drug coverage.

Coverage began in 2023, following a decision by the Centers for Medicare & Medicaid Services (CMS) to expand coverage for essential vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). The CDC recommends the RSV vaccine for all adults aged 75 and older, and for adults aged 60 to 74 with certain health conditions that increase their risk of severe RSV, such as chronic heart or lung disease or a weakened immune system.

Accessing the RSV Vaccine

Medicare beneficiaries can obtain the RSV vaccine at various locations, including pharmacies, doctor’s offices, and community health centers. When planning to receive the vaccine, bring your Medicare card and any other relevant insurance information.

Before administration, confirming coverage directly with the provider or pharmacy is a practical step. This ensures the location is in-network with your specific Medicare Part D or Medicare Advantage plan, helping to avoid unexpected costs. While a prescription may be required in some areas to get the vaccine at a pharmacy, discussing the best location for vaccination with your healthcare provider or pharmacist is beneficial.

Financial Considerations

While the RSV vaccine is covered by Medicare Part D and Medicare Advantage plans with drug coverage, beneficiaries should understand potential financial implications. For those with Part D coverage, there are typically no out-of-pocket costs, such as copayments or deductibles, for the vaccine itself. This is because ACIP-recommended vaccines are generally exempt from these cost-sharing rules.

Monthly premiums for a Medicare Part D plan or a Medicare Advantage plan still apply and vary depending on the specific plan chosen. For instance, the national base beneficiary premium for Part D was around $36.78 in 2025, and the average monthly premium for Part C plans was approximately $17.00 in 2025. Contacting your specific Medicare plan provider to confirm individual cost responsibilities and network providers before receiving the vaccination is advisable.