Is the RSV Vaccine Covered by Medicare?
Unsure about RSV vaccine coverage with Medicare? Get reliable answers on benefits, costs, and practical steps to get vaccinated.
Respiratory Syncytial Virus (RSV) is a highly contagious respiratory virus that can lead to severe lung infections. While often associated with infants, RSV poses a significant threat to older adults, potentially causing serious conditions such as pneumonia or bronchiolitis. An RSV infection can worsen existing chronic health issues for older adults, leading to hospitalization and, in severe cases, life-threatening outcomes. Vaccination offers a protective measure against these serious complications, preventing severe illness and reducing hospital visits.
Medicare Coverage Details
Medicare generally provides coverage for the Respiratory Syncytial Virus (RSV) vaccine. The primary avenue for this coverage is through Medicare Part D, which encompasses prescription drug plans. Since 2023, the Centers for Medicare & Medicaid Services (CMS) has confirmed that RSV vaccines should be available without charge to individuals enrolled in Medicare Part D. This aligns with a broader initiative ensuring Part D covers all adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC).
While Medicare Part D is the main component covering the RSV vaccine, Original Medicare Part B typically does not cover this specific vaccine. Part B usually covers certain preventive vaccines like influenza, pneumococcal, and COVID-19 vaccines, but the RSV vaccine falls under the prescription drug benefit. Eligibility for the RSV vaccine includes adults aged 60 and older, as approved by the U.S. Food and Drug Administration (FDA).
The CDC recommends the RSV vaccine for all adults aged 75 and older, and for those aged 50-74 who have increased risk factors for severe RSV disease, such as chronic heart or lung conditions, weakened immune systems, or those residing in nursing homes. Medicare coverage aligns with these recommendations for qualifying individuals. If a beneficiary has a Medicare Advantage plan (Part C) that includes prescription drug coverage, the RSV vaccine will be covered through that plan’s drug benefit.
Out-of-Pocket Costs
For individuals with Medicare Part D, the Inflation Reduction Act, as of 2023, eliminated cost-sharing for all ACIP-recommended vaccines, meaning beneficiaries generally pay nothing for the RSV vaccine itself. However, beneficiaries enrolled in Part D plans are still responsible for their monthly plan premiums, which vary significantly depending on the specific plan chosen. For instance, the national base beneficiary premium for Part D was about $36.78 in 2025. Medicare Advantage plans that include drug coverage may also have a monthly premium, averaging approximately $17.00 in 2025.
Individuals without Part D coverage may face substantial out-of-pocket expenses for the RSV vaccine, with costs ranging from approximately $180 to $550. Medicare beneficiaries should review their specific Part D or Medicare Advantage plan documents or contact their plan provider to understand potential costs and verify coverage details.
Receiving the RSV Vaccine
The vaccine is available at doctor’s offices, local pharmacies, and community health clinics. When visiting a vaccination site, individuals should provide their Medicare information to allow direct billing to their Part D plan. While most Part D plans cover the vaccine without upfront costs, some patients might need to pay and then seek reimbursement from their plan.
The RSV vaccine can be safely administered alongside other routine vaccinations, such as the COVID-19 vaccine or annual flu shot. Although eligible adults can receive the RSV vaccine at any time throughout the year, healthcare professionals often suggest getting vaccinated in the late summer or early fall. This timing ensures protection before the typical RSV season begins.