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Does Medicare cover flu shots?

Cropped SingleCare logo By | January 30, 2020
Medically reviewed by Kristi C. Torres, Pharm.D.

Flu shots are essential to protect your health during the fall and winter months.

Flu season typically begins in November and lasts through April. The highest number of cases usually occur between December and February. The 2018-19 flu season was unusual in that it lasted until May. Influenza, informally called the flu, causes fever, cough, sore throat, headaches, fatigue, and body aches.

For those over the age of 65, the flu is dangerous and potentially life-threatening. This population has the highest risk of developing complications from the flu, according to the Centers for Disease Control and Prevention (CDC), which can lead to hospitalizations and even death. During the 2018-19 flu season, 42.9 million people got sick, 647,000 were hospitalized, and 61,200 died. 90% of all hospitalizations from the flu occurred in people over the age of 65 years old, according to a study co-authored by CDC and published in 2019.

Getting an annual flu shot is the single best way to prevent the seasonal flu and its complications, according to the CDC. Some people who get the flu shot might still get sick; however, research shows that people who get the flu after receiving the vaccine have milder symptoms and a reduced risk of being hospitalized.

If you’re 65 or older, you should contact your doctor immediately if you have symptoms “such as fever, chills, headaches and body aches,” explains Ishani Ganguli, MD, assistant professor of medicine at Harvard Medical School. “It is also important to seek medical help for severe symptoms, such as a fever above 104 [degrees], trouble breathing, and confusion,” Dr. Ganguli explains.

Does Medicare cover flu shots?

After your 65th birthday, you are eligible for Medicare coverage, and fortunately, Medicare covers flu shots. However, not every Medicare program includes free flu shots. Medicare Part B and C (Medicare Advantage Plans) cover the full cost of the flu shot if you use a pharmacy or healthcare provider that accepts Medicare payments. Just call ahead to verify they take Medicare.

How to get Medicare coverage for flu shots

There are several parts of Medicare, according to the Centers for Medicare and Medicaid Services. Learning what each part covers can help you choose the plan that is most advantageous for you.

Medicare Part A covers hospital stays—flu shot not included

Medicare Part A covers hospitalizations, skilled nursing facilities, hospice, and home health care. It does not cover the flu shot.

It’s free to eligible people aged 65 or older. Generally, if you or your spouse paid Medicare taxes for at least 10 years, this portion of Medicare is free. You can sign up for benefits starting three months before you turn 65. If you received social security benefits before you were 65, you are automatically enrolled in Part A. Otherwise, you need to sign up for it either online or at a social security office.

Medicare Part B covers preventive services, including flu shots

Medicare Part B is your medical insurance. It covers preventive services, like the flu shot. Medicare pays for one shot per season, but may cover a second if it’s medically necessary. Medicare coverage includes flu shots that are approved by the U.S. Food and Drug Administration (FDA) for people over the age of 65. Covered flu shots include Fluad and Fluzone High-Dose, according to the CDC.

Dr. Ganguli recommends the high-dose flu vaccination for anyone over the age of 65.

There are other types of influenza vaccines approved for adults, however, not specifically for people over the age of 65. These include:

Medicare does not cover nasal spray flu vaccines, as the FDA has not approved them for this age group.

Medicare Part B also covers a seasonal H1N1 swine flu vaccine, a pneumococcal vaccine, and hepatitis B shots for individuals considered high-risk.

Part B also includes certain shots if they’re related to treatment for illness or injury. For example, if your doctor treats an injury with a tetanus shot.

Part B is optional, and some people who have employer insurance, themselves or through their spouses, might opt to keep that insurance and sign up for Part B later. You can sign up for this during your initial enrollment period, the same as with Part A. You can also sign up for eight months after you stop working or lose insurance coverage. If you choose not to sign up for Part B but were eligible to do so, you might need to pay a late enrollment penalty.

Medicare Part C includes Parts A and B—flu shot included

Medicare Part C plans provide Part A and Part B benefits. Meaning, Medicare Part C covers flu shots. Some Part C plans also include prescription drug coverage. You would sign up for this during the enrollment period as well.

Medicare Part D covers prescriptions and other vaccines you may need

Medicare Part D is an optional prescription drug plan. Plans vary in copayments, coinsurance, deductibles, and drug coverage. These plans cover other vaccines—besides the flu shot—when they are reasonable and medically necessary. Common vaccines covered under Part D include:

  • Shingles vaccine: All Part D plans must cover the shingles vaccine. There are two types of FDA-approved shingles vaccines, Zostavax (zoster) and Shingrix (recombinant zoster). The Shingrix vaccine has been available since 2017 and is the preferred shingles vaccine.
  • Tdap vaccine for tetanus, diphtheria, and pertussis (also called whooping cough)
  • MMR (measles, mumps, rubella) vaccine
  • BCG vaccine for tuberculosis
  • Meningococcal vaccines
  • Hepatitis A and hepatitis B vaccines for individuals considered high-risk

“The amount you pay for your vaccine may vary depending on where you get vaccinated. Be sure to check your plan’s coverage rules and see where you can get your vaccine at the lowest cost,” says Gail Trauco, RN, BSN-OCN, a patient advocate and founder of Medical Bill 911. “Typically, you will pay the least for your vaccinations at in-network pharmacies or at a doctor’s office that coordinates with a pharmacy to bill your Part D plan for the drug and the injection.”

To enroll in Medicare plans, speak with a health insurance agent, inquire at a Social Security office, or visit Medicare.gov. Although Part A is free to those who are eligible, you will pay a monthly premium for Part B, C, and D.

Private companies offer Medigap coverage, which are Medicare supplement insurance plans. These plans work alongside your Original Medicare (Part A and B) and might help pay for copayments and coinsurance. There are many different types of Medicare supplement plans so it is essential to determine which one is best for you. An insurance agent who specializes in working with seniors can help you decide between different plans.

Are flu shots free for seniors?

Seniors who have Medicare Part B or C are eligible for one free flu shot per year. Some seniors, however, do not have these Medicare plans and might need to pay out of pocket for the flu shot.

Without Medicare, Medicaid, or other health insurance, the cost for Fluad or Fluzone High-Dose can range from $139 to $160 depending on your pharmacy. Some pharmacies provide flu shots to seniors for about $70. You can also check with your local senior center or county health department to find out if there are any places in your area providing free flu shots for people without insurance.

You can find discounted prices using coupons from SingleCare. Search “Fluad” or Fluzone High-Dose” on SingleCare.com or the SingleCare app. As of January 2020, the cost of Fluad and Fluzone High-Dose started at $56 with our savings.