Does Medicare Cover the Cost of a Flu Vaccine?
Key takeaways:
A flu shot helps protect you from serious illness caused by the influenza virus. Nine flu shots are available for the 2024-2025 flu season.
The recommended flu shots for people age 65 and older often cost more than other flu vaccines. The retail price for shots for older adults is $60 to $120.
Medicare Part B and Medicare Advantage will cover your flu vaccine at 100% if the healthcare professional who administers the shot has been approved by Medicare.
Table of contents
Influenza, also called the seasonal flu, is nothing to sneeze at. The influenza virus causes a highly contagious respiratory sickness that affects your nose, throat, and lungs. It spreads through tiny droplets when an infected person coughs, sneezes, or talks.
The Centers for Disease Control and Prevention (CDC) estimates that there were 34 to 75 million cases of the flu in the U.S. during the 2023-2024 flu season. Many people experience mild symptoms, like body aches, fatigue, and fever. But the flu can lead to serious complications for children under age 2 and adults 65 and older.
Getting an annual flu shot helps prevent serious illness. Flu shots can be more expensive for adults 65 and older, but Medicare may cover the bill if you meet certain requirements.
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Does Medicare cover flu shots?
Yes. Flu shots are covered under Medicare Part B and Medicare Advantage plans (Part C). Medicare Part B pays for medical expenses. It covers one flu shot per flu season with a healthcare professional who accepts Medicare. It does not require a physician’s order or supervision.
In general, Medicare will pay for two flu shots in a calendar year during two separate flu seasons. Medicare will also cover additional flu shots if a healthcare professional orders it as a medically necessary treatment.
Medicare Advantage plans include Medicare Part A and Part B. Medicare approves private insurers to sell Advantage plans. They must cover the same basic benefits as original Medicare, which includes the flu vaccine.
How do the different parts of Medicare cover flu shots?
Medicare has separate parts that cover different aspects of your medical care. Each piece has its own guidelines and limitations. Here’s a snapshot of Medicare’s flu shot benefit coverage.
Medicare plan type | Flu shot coverage |
|---|---|
Part A (inpatient hospital insurance) | Not a covered benefit under Part A |
Part B (outpatient medical insurance) | Covered at 100% under Part B |
Part C (bundles Part A and Part B, some include Part D) | Still covered at 100% under Part B |
Part D (prescription medication insurance) | Does not cover flu shots but may cover some other vaccines |
What kind of flu shots are available?
A flu shot is like any other vaccine that protects against illnesses. The flu shot contains killed or weakened influenza viruses that do not harm you. Instead, they trigger your immune system to produce antibodies. These antibodies help your immune system recognize the flu virus and fight it off.
For the 2024-2025 flu season, the FDA has approved nine types of flu vaccines. Getting older makes it harder for the immune system to fight off viruses and respond to vaccines. To get the best protection, the flu vaccines recommended for people 65 and older include:
Recommended flu vaccines for people age 65 and older | Potential allergens |
|---|---|
Egg protein, kanamycin, neomycin, polysorbate 80 | |
Polysorbate 20 | |
Egg protein |
Keep in mind that if one of these vaccines isn’t available, it’s recommended to still get vaccinated with a standard-dose flu vaccine that’s approved for your age range. These vaccines still offer protection. It’s better to receive one of these flu shots than to not be vaccinated.
How much does the flu vaccine cost without Medicare?
Flu vaccines for people 65 and older can be more costly than flu shots for younger people. The average price for the recommended vaccines ranges from $60 to $120. Prices may vary by location. But if you need to pay out of pocket, you can save money by using the GoodRx coupon.
Recommended flu vaccines for people age 65 and older | GoodRx price |
|---|---|
Where can I get the flu shot under Medicare?
You can get your Medicare-covered flu shot from any qualified healthcare professional. But they must be approved by Medicare to administer flu shots. Locations to get flu shots include:
Healthcare professional offices
Clinics
College health centers
Health departments
Pharmacies
Some schools and workplaces
Urgent care clinics
No insurance? Here’s how to get a low-cost or free flu shot.
Which flu vaccine is best for people over 65? The Centers for Disease Control and Prevention recommends the top three most effective flu vaccines for older adults.
Does the flu shot really work? Get all the details on how the flu vaccine can protect you and others from serious illness.
Medicare also follows CDC guidelines. The CDC recommends that people 65 and over get a flu shot in September or October. This helps ensure protection will last throughout the flu season. But if you’ve missed this window, there are still benefits to getting your flu vaccine later.
How do I get flu shots covered by Medicare?
The Affordable Care Act requires health insurance companies to cover the flu shot and other preventive care vaccines. This includes government health insurance programs like Medicare.
You can get a flu shot from a qualified healthcare professional when the following requirements are met:
The person giving the shot accepts a Medicare assignment to provide flu shots.
You have Medicare Part B.
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Most medical offices and pharmacies also accept Medicare Advantage plans. But you may need to get your flu shot from a healthcare professional who is in your health plan’s network. Check with your insurer to verify the requirements before getting your flu shot.
In general, Medicare does not require prior authorization or a physician’s order for a flu shot. But some states may have these requirements.
Where can I find free or low-cost flu vaccines?
Flu shots for people age 65 and over range from $60 to $120, depending on where you get vaccinated. Fortunately, many places offer free or low-cost flu shots for people without insurance. Here are a few options:
Employer voucher programs
Pharmacies
Nonprofit organizations like WellSpan Health
School health clinics
Since the flu vaccine falls under preventive care, people with Medicare Part B are covered at 100%. They do not need to pay deductibles, copays, or coinsurance. If you don’t have Medicare Part B, you will pay the same price as someone without insurance.
If you are paying for your flu shot out of pocket, the GoodRx Flu Vaccine Program can help. GoodRx works with leading pharmacies to help you get the best price. If you’re 65 or older, you can get flu shots for as low as $65, depending on the pharmacy and the state you’re in. That includes the administrative fee that often comes with getting a flu shot without insurance.
Can Medicare supplemental insurance help cover flu shots?
It won’t be necessary. To get a Medigap policy, you must have Medicare Part A and Part B. Medigap supplemental insurance is designed to cover what original Medicare does not. If you have Medicare Part B, your flu shot is already covered at 100%.
Frequently asked questions
You should get a flu shot every year. The flu virus changes constantly, so last year’s vaccine likely won’t protect you from this year’s flu. Plus, your immune protection from the vaccine can decrease over time. Getting an annual flu shot reduces your risk of getting sick and can make the illness less severe if you catch it. It also helps prevent serious illness and death and reduces the spread of the flu to people who can’t get vaccinated.
An additional flu shot may be medically necessary if a healthcare professional determines that your immune system didn’t respond well to the first dose. It may also be medically necessary if you’re at high risk for serious complications due to certain health conditions, such as heart disease, diabetes, or a weakened immune system. Children age 6 months to 8 years may also require two doses during a single flu season. It might also be recommended if there’s a new flu strain circulating after receiving your initial shot. Always consult a healthcare professional to see if you need a second flu shot.
The bottom line
Flu vaccines reduce your risk of serious illness from the influenza virus. Shots recommended for people age 65 and older may cost $60 to $120, which is more than the shots younger people usually receive. But if you are enrolled in Medicare, you may not have to pay for a flu shot.
Medicare Part B (available through original Medicare or Medicare Advantage plans) covers the total cost of a flu shot. But healthcare professionals must accept a Medicare assignment to provide flu shots.
Why trust our experts?
References
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