Does Medicare Cover Flu Shots?

The flu (influenza) is a highly contagious respiratory illness that affects 9 million – 45 million Americans yearly. The range is so wide because many cases are not diagnosed every year.

The flu can cause a mild to severe illness that can infect the nose, throat and at times the lungs.  Many times the flu can lead to hospitalization and even death.  The only way to try to prevent  the flu is by getting the flu vaccination every year.  Most insurances cover the vaccine, but if you have medicare the coverage is dependent on the type of medicare you have.

General Coverage Under Medicare

Coverage under medicare can be a bit tricky.  If you are 65 years or older, Medicare will cover 100% of the cost of your flu shot from a medicare-enrolled provider.  In addition, medicare will cover the doctor visit to get the flu shot.  If you choose to visit a pharmacy for the shot, you must go to an approved one.  This even covers high dose flu vaccines, but does not cover the nasal mist flue vaccine.  They will pay for one flu vaccine per season.

Medicare Advantage Plans

Medicare Advantage plans have to provide the same level of of services that the original medicare offers.  That is why they provide flu vaccine coverage for all flu shots that are FDA approved.  You will most likely not require a referral to receive the flu shot, but you will have to stick with your in-network providers.  You will most likely have to follow the out-of-pocket costs under the Medicare Advantage Plan.

Medicare Part B

Medicare Part B is a part of  the original medicare program.  Part B will fully cover a flu shot as long as you receive the vaccine during Fall or Winter.  You cannot use your Part B deductible for the flu shot, which is why medicare covers the flu shot as long as you are enrolled in Original Medicare.  You don’t even have to see a medicare approved provider.  Just make sure that your provider accepts medicare before you make an appointment to get the vaccine.

You can always check the Medicare website for providers who will accept medicare in your area.  Once you have found a provider, you should discuss your flu shot options.