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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 occurs between December and February. Influenza, informally called the flu, causes fever, cough, sore throat, headaches, fatigue, and body aches.
For those older than 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— the last “normal” flu season—42.9 million people got sick; 647,000 were hospitalized; and 61,200 died in the United States. Ninety percent 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. The statistics for the previous two years are lower than typical due to the impact of the COVID-19 pandemic.
Getting an annual flu shot is the single, best way to prevent the seasonal flu and its complications, according to the CDC. (It’s also important to get a COVID-19 vaccination as the two viruses spread this winter.) Some people who get the flu shot might still get sick; however, a study published in 2018 found that people who did get the flu after getting the vaccine had milder symptoms and a reduced risk of being hospitalized.
“For those older than 65, those with major medical conditions, such as diabetes or asthma, have weak immune systems, for example from chemotherapy, or live in a nursing home, doctors should be notified of flu symptoms, such as fever, chills, headaches and body aches,” says Ishani Ganguli, MD, an 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.”
Does Medicare cover flu shots?
If you’re 65 or older, 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. When using a healthcare provider for the first time, call ahead to verify they accept Medicare assignments.
How to get Medicare coverage for flu shots
There are several parts of Medicare: Part A, Part B, Medicare Advantage (Part C), and Part D. It is best to learn what each part covers and what is most advantageous for you.
Medicare Part A covers hospital stays—flu shot not included
Medicare Part A covers:
- Hospitalizations
- Skilled nursing facilities
- Hospice
- Home health care
It does not cover the flu shot.
Medicare Part A is 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 this starting three months before your 65th birthday. If you have been receiving social security benefits before your 65th birthday, 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 older than 65.
There are other types of influenza vaccines approved for adults, however, not specifically for people over the age of 65. These can be given to people over 65 years of age if the high-dose flu vaccine is unavailable or not preferred for any reason. These include:
- Standard dose quadrivalent shots including Afluria Quadrivalent, Fluarix Quadrivalent, FluLaval Quadrivalent, Fluzone Quadrivalent
- Quadrivalent cell-based influenza shot including Flucelvax Quadrivalent
- Recombinant quadrivalent influenza shot including Flublok Quadrivalent
Medicare does not cover nasal spray flu vaccines, as the FDA has not approved them for this age group.
Medicare Part B also covers COVID-19 vaccines, 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, either through themselves or their spouse, 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 it for up to 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 both Part A and B benefits. With Part B benefits included, Medicare Part C covers flu shots. Some Part C plans also include prescription drug coverage, generally covered under Medicare Part D. You would sign up for this during the enrollment period as well.
Medicare Part D covers flu medications 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 when they are reasonable and medically necessary. Common vaccines covered under Part D include:
- All Part D plans must cover the shingles vaccine, Shingrix
- 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,” says Gail Trauco, RN, BSN-OCN, a patient advocate and founder of Medical Bill 911. “Be sure to check your plan’s coverage rules and see where you can get your vaccine at the lowest cost. 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.”
Although the flu shot is not covered by Medicare Part D, antiviral medications used to treat the flu are covered. These include generic Tamiflu, Relenza, and Xofluza.
Are flu shots free for seniors?
For seniors who have Medicare Part B, C, or D, one flu shot per year is free. Medicare will cover two flu shots if a second shot is deemed medically necessary by a healthcare provider. 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 $130 to $220 depending on your pharmacy.
RELATED: How to get a discounted or free flu shot
You can find discounted prices using coupons from SingleCare. As of March 2023, the cost of Fluad and Fluzone High-Dose starts at $55 with our free drug coupons.
Get Fluad coupons | Get Fluzone High-Dose coupons
What to expect from your flu shot
You can get your annual flu shot from any pharmacy or provider who accepts Medicare. You can find the contact information (phone number, address, pharmacy hours) for a pharmacy near you on SingleCare here. Call ahead if you’re unsure whether Medicare is accepted.
One large study showed that people who received a high-dose flu vaccine were more likely to develop side effects during the week after vaccination compared to those who got a standard-dose flu vaccine. Common side effects include:
- Headache
- Injection site irritation
- Muscle aches
- Fatigue
However, another study found that the high-dose vaccine was 24% more effective in preventing influenza in seniors than standard-dose vaccines. In most cases, the risk of vaccine side effects outweighs the risk of flu complications.
Although it may be tempting to take a pain reliever before or after vaccination, you should ask your healthcare provider first. Common over-the-counter pain medications, such as Tylenol, aspirin, naproxen, and ibuprofen, have been shown to reduce the efficacy of flu vaccines. However, if you have been prescribed pain relievers, such as low-dose aspirin to prevent heart disease, you should always talk to your healthcare provider before discontinuing medication.
People aged 65 and older with underlying health conditions are now eligible for a COVID-19 booster shot. The CDC has stated that it is safe to get a COVID-19 vaccine or booster shot at the same time or in close proximity to getting a flu vaccine.
