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Fluzone quadrivalent Medicare coverage

Used for Flu Vaccination

The flu vaccine is given to lower your risk of getting the flu from the influenza virus. There are multiple types of flu vaccines available, including high-dose flu shots for older adults (e.g. Fluzone High-Dose Quadrivalent), egg-free flu shots (Flucelvax Quadrivalent), and a nasal spray flu vaccine (e.g. FluMist Quadrivalent). Most people should get a flu vaccine every year. The effectiveness of flu vaccine changes from year to year because the influenza virus itself changes over time. General side effects for the flu shot include pain at the injection site, headache, and muscle aches. Side effects from the nasal flu vaccine include stuffy nose and sore throat.

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Annual Notice of Change (ANOC):

The Medicare Annual Notice of Change (ANOC) is a letter for people enrolled in Medicare Advantage plans and anyone with Medicare Part D prescription coverage. People with Medicare Advantage or original Medicare (Part A and/or Part B) can have Part D plans. The ANOC informs enrollees about any changes to their benefits for the coming coverage year. By law, Medicare Advantage and Part D plans must send the ANOC to enrollees by September 30 — which is before the annual Medicare open enrollment period of October 15 to December 7. Even if you have the same plan, your benefits could change year to year.

Premium:

A premium is the cost of having a health insurance plan and is usually paid monthly. Medicare enrollees may pay several premiums. Most people don’t pay anything for Part A hospital insurance, but some people do depending on how long they worked and paid taxes. For outpatient and preventive coverage, the Part B standard premium is $185 a month in 2025, but people with higher incomes pay more. Your premium for Medicare Advantage plans will vary, but even so-called “zero premium” plans require you to pay your Part B premium. Part D premiums range in price, but the average is about $47 a month in 2025. If you have original Medicare and a Medigap supplement plan, you have an additional premium for that coverage.

Deductible:

A deductible is the amount you pay out of pocket before your Medicare plan begins cost-sharing. In 2025, the Part A deductible is $1,676 per benefit period. The Part B deductible is $257 for the year, but you can access certain preventive care — including some vaccines — without meeting your deductible. Medicare Advantage deductibles vary and your Part D deductible can’t exceed $590 in 2025.

Out-of-pocket limit:

Original Medicare has no annual out-of-pocket maximum. Medicare Advantage plans have out-of-pocket limits. In 2025, they are $9,350 for in-network covered services and $14,000 for in-network and out-of-network covered services combined.

Medicare Prescription Payment Plan:

Starting January 1, 2025, anyone with Part D coverage had the option to use the Medicare Prescription Payment Plan for their out-of-pocket medication costs instead of paying upfront at the pharmacy. This plan doesn’t provide savings, but allows you to spread prescription costs — including your deductible — over the year. Making payments can be particularly helpful for people who may skip or delay picking up prescriptions because of high costs early in the year. Also in 2025, the Part D out-of-pocket limit dropped to $2,000.

Initial coverage phase:

After a Medicare enrollee meets the Part D deductible (if the plan has one), the health insurance begins cost sharing. The initial coverage phase means you pay coinsurance or a copay for covered prescriptions.

Catastrophic phase:

When you reach the $2,000 out-of-pocket maximum, your Part D plan pays for 100% of covered medications for the rest of the year.

Medication ready
How to save on drugs with Medicare

Medicare Part D is the part of Medicare that helps cover prescription medications, including both brand name and generic. It also includes coverage for certain vaccines that aren’t covered by Part B, as well as some medical supplies.

Even with Medicare Part D coverage, you may still have out-of-pocket costs such as premiums, deductibles, copayments, and coinsurance. As of 2025, Medicare Part D plans include a $2,000 annual out-of-pocket cap. Once you reach this limit, your plan covers the full cost of your covered medications for the rest of the year.

Still, there are several ways to reduce your prescription medication cost. From GoodRx coupons to patient assistance programs, here are ways you can save money on the medications you need.

1. See if you qualify for Medicare’s Extra Help program

The Medicare Extra Help/Low-Income Subsidy program is a federally funded program for people covered under a Medicare Part D plan. It helps reduce enrollees’ out-of-pocket costs by limiting their deductibles and copays. To qualify, your income and assets fall below a certain limit.

If you’re eligible, you may receive:

  • No monthly premiums for Medicare Part D

  • No Medicare Part D deductible

  • Low copays for prescription medications

2. Use GoodRx coupons

You can’t combine GoodRx coupons with Medicare, but you can choose to use a coupon instead of your insurance if it results in a lower price.

Here’s how to download a GoodRx coupon:

  1. Go to the GoodRx website, or download the GoodRx app on your phone.

  2. Search for your prescription medication.

  3. Enter your prescribed dose and quantity, then set your location.

  4. Compare prices across different pharmacies in your area.

  5. Click “Find the lowest prices” or press “Enter.”

  6. You can have the coupon sent by text or email, or print it out.

  7. To apply the discount, show the coupon at the pharmacy when you fill your prescription. Ideally, this is done at drop-off before the prescription is filled.

3. Consider the Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan is a new program that can help make paying for medications more manageable. It’s open to anyone with a standalone Part D plan or those with Medicare Advantage plans that offer prescription medication coverage.

There is no cost to participate in the Medicare Prescription Payment Plan and participation is voluntary. Instead of paying for the total cost of your medications up front at the pharmacy, the payment plan allows you to spread the cost into smaller payments during the year. If you join, you will continue to pay your premium every month as well as an additional monthly amount on your payment plan. It’s a good idea to review how the Medicare Prescription Payment Plan works to determine if it’s right for you.

4. Compare Part D plans during open enrollment

Medicare open enrollment, which takes place every year from October 15 to December 7, is your chance to switch plans if another option offers better prescription medication coverage or lower costs. Plan costs and coverage details can change each year, so it’s important to review your options.

Here are some steps to help you compare plans:

  1. Make a list of all your medications and what dosages you take.

  2. Enter the names of your prescription medications to see which plans offer the best coverage.

  3. Look at premiums, deductibles, and medication costs for each plan. Plans usually change their formularies, premiums, and copays annually.

  4. Check if your preferred pharmacy is in each plan's network.

5. Get a 90-day supply

Opting for a 90-day supply instead of a monthly refill of your medication might help reduce your long-term out-of-pocket costs. Many insurance plans offer lower copays or bulk pricing for 3-month prescriptions.

If your medication is covered under your plan, see if your insurer’s mail-order or specialty pharmacy provides savings on a 90-day supply. If they do, ask your prescriber to write a prescription for a 90-day quantity to take advantage of these potential savings.

6. Ask about the generic version of your medication

Some medications have a generic version, and they generally cost less than the brand-name prescriptions. Generic medications are just as safe and effective as brand-name medications, so it’s an option worth considering to reduce your cost. Ask your prescriber about switching to a generic version of your medication to save money.

7. Consider lower-cost alternative medications

There may be other medications that help manage your condition, and they may cost less. If your medication is costly or not covered by your insurance, talk to your prescriber about lower-cost alternatives that might be a good option for you. Alternatives might have better insurance coverage or lower costs.

8. Learn more about patient assistance programs

Patient assistance programs (PAPs) offer free or low-cost medications to uninsured and low-income consumers. These programs, which primarily offer savings on brand-name medications, are usually run by private pharmaceutical companies or nonprofit organizations. You must meet certain qualifications and complete paperwork to receive savings from PAPs. However, some PAPs exclude Medicare recipients, so it’s important to review the program’s rules and requirements carefully.

9. Check state-funded resources

Depending on where you live, your state may offer programs to help you navigate prescription medication costs. A good place to start is your local Department of Aging. This U.S. Department of Health and Human Services office can help you find the best Medicare plan for the coverage you need.

Some states even have their own cost-saving programs for older adults. For example, Pennsylvania runs PACE and PACENET. These programs help eligible residents get prescription medications at reduced costs.

Alternatively, you can find out if your state has a State Pharmaceutical Assistance Program by using Medicare’s search tool. These programs are state-run and help qualifying residents pay for prescription medications.

10. Use a health savings account to pay for prescription medications

Although you can’t contribute to a health savings account (HSA) after enrolling in Medicare, you can still use any remaining funds in your account to pay for qualified medical expenses. An HSA allows you to use tax-free dollars to pay for eligible prescription medications. The money in your account does not expire so you can use your funds at any time to reduce your out-of-pocket medication costs.

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Frequently asked questions about Fluzone quadrivalent

No, you can't get the flu from the Fluzone quadrivalent. Fluzone quadrivalents are made with dead or weakened viruses that can't cause an infection. However, some people might experience flu-like symptoms, such as headache or body aches, after getting a Fluzone quadrivalent. These symptoms might be caused by a few reasons: (1) One possibility is that these are side effects from the Fluzone quadrivalent. If so, the symptoms should get better in a couple of days. (2) Another possibility is that you got sick from another virus that causes similar symptoms as the flu. (3) A third possibility is that you caught the flu. This can happen if you were exposed to the flu virus before your body was able to build up full protection against the virus after the Fluzone quadrivalent (which typically takes about 2 weeks).

It's tough to say how well the Fluzone quadrivalent will work before the flu season starts. This is because researchers can predict, but won't know for sure, how the flu virus will change and spread each year. In general, Fluzone quadrivalents can protect you against the flu 40-60% of the time. Keep in mind that there are multiple types of Fluzone quadrivalent and some are recommended for certain groups of people. For example, the high-dose flu shot (Fluzone High-Dose Quadrivalent) is one of the vaccines specifically recommended for older adults because it can help older adults build better protection against the flu virus. Ask your provider if you've any questions about how well the Fluzone quadrivalent works and whether a particular one is recommended for you.

Your protection from the Fluzone quadrivalent lasts about a year. This is because the flu virus changes year to year, so the vaccine and its protection against the virus changes year to year.

You can still get the Fluzone quadrivalent when you're sick only if you have mild symptoms, like a low-grade fever, slight cough, or runny nose. But if your illness symptoms are moderate or severe, your provider will likely ask you to wait before getting the Fluzone quadrivalent. If you're not sure if you can receive a Fluzone quadrivalent, just ask your provider.

Let your provider know if you have an egg-allergy. Many Fluzone quadrivalents are made using viruses grown in eggs, so there's a risk that these vaccines can cause an allergic reaction in people with an egg-allergy. However, there are a few Fluzone quadrivalents that aren't made using eggs and are possible options for people who are allergic to eggs. Egg-free Fluzone quadrivalents include Flucelvax Quadrivalent (for people 6 months and older) and Flublok Quadrivalent (for people 18 years and older)

The CDC recommends that people age 65 years and older receive a Fluzone quadrivalent that can help better protect them against the flu virus. A high-dose Fluzone quadrivalent (Fluzone High-Dose Quadrivalent) is one possible option for older adults. The other options include Flublok Quadrivalent and Fluad Quadrivalent, which are also made to trigger stronger protection against the virus. If your local clinic or pharmacy don't have these Fluzone quadrivalents in stock, you're recommended to get a standard-dose Fluzone quadrivalent instead.

Yes. If you're due for both, it's safe to get the Fluzone quadrivalent and the COVID vaccine at the same time. This way, you won't need to make two separate vaccine appointments.

Yes, you're recommended to get the Fluzone quadrivalent if you're pregnant. This is because getting sick with the flu while pregnant can be dangerous to both the mother and her unborn child. But, you shouldn't get the nasal spray Fluzone quadrivalent since experts don't know how it affects unborn babies.