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Medicare

Medicare’s Flu Shot Coverage for 2023

Does Medicare Cover Flu Shots EDITED

Does Medicare Cover Flu Shots?

Yes, Original Medicare covers flu shots at no cost under Part B since they’re considered preventative, outpatient care. Additionally, because Medicare Advantage plans are required to offer the same coverage as Original Medicare, Medicare Advantage plans also cover flu shots 100% free of charge when given by a participating provider.

Occasionally, doctors may prescribe patients a second flu shot during the same flu season if seen as medically necessary. If the patient needs a second flu shot, Medicare Part D will cover the shot at no additional cost. Without Part D, the recipient will pay for the shot out of pocket. Medicare Advantage will also often cover a second annual flu shot if prescribed by a doctor. However, the cost and coverage availability of the second immunization will depend on your specific Medicare Advantage plan.

Do You Need a Flu Shot?

The CDC estimates that 36,000,000 people came down with the flu between November 2019-April 2020, with 63% of related deaths found in individuals over the age of 65. While the flu can be dangerous to some individuals, particularly senior citizens, a great way to prevent infection is to get vaccinated against it annually.

Each year the government and pharmaceutical industry produces a re-formulated vaccine explicitly designed to target that year’s influenza virus. However, with vaccination a yearly proposition, you may wonder who pays for it. Read this article to learn whether Medicare covers your annual flu immunization.

Centers for Medicare and Medicaid Services, or CMS, recommend a specific regimen of shots for Medicare recipients to keep them healthy through the flu season. Some Medicare recipients can access preferred vaccine doses. Preferred vaccines are more potent than the doses that the general public can access.

The primary forms of the preferred flu vaccine are:

  • The Fluzone High-dosage Quadrivalent Vaccine supplies four times the antigens vs. a regular flu vaccine. Because the older populations’ immune systems can be less robust than the younger populations, experts recommend that those over 65 get this strength of dosage for protection.
  • The Flublok Quadrivalent Recombinant Flu Vaccine covers four strains of influenza (quadrivalent) instead of three (trivalent), providing broader coverage against the most common circulating virus strains. Further, it does not require organic material as part of the production process and therefore is less likely to be subject to shortages.
  • The Fluad Quadrivalent Adjuvanted Flu Vaccine is supercharged with the adjuvant MF59. An adjuvant is an ingredient added to vaccines to increase the immune response that the body produces. MF59 is an emulsion of squalene oil and water. MF59 is found naturally in animals, plants, and humans.

Does Medicare Cover Nasal Spray Flu Vaccines?

Medicare does not cover the nasal flu vaccine. The nasal flu vaccine is only intended for use in individuals aged 2 to 49. Because Medicare is mainly used by individuals over 65, there would be little benefit to offering it. Further, the previously mentioned preferred doses do not come in nasal form, with only the standard type available.

Why You Should Get Your Flu Shot

While the “flu season” is an annual occurrence, the flu that goes around each year is a slightly different version than it was the year before. To maximize the vaccine’s benefit, the pharmaceutical companies that develop and produce the shots re-calibrate their formula to match the qualities of that year’s virus. Therefore, getting vaccinated regularly allows an individual to build immunity over time, thus further decreasing the likelihood of infection and severe illness.

With that in mind, one should consider getting vaccinated at the beginning of the flu season, usually around October or November. That way, you can avoid exposure to a virus to which you will have limited immunity and gain the greatest amount of protection possible.

Where to Get a Flu Shot

Medicare recipients can get the flu shot from anywhere that accepts Medicare. Fortunately, Medicare has agreements with several of the most popular pharmacies, including Costco, CVS, Walgreens, Albertsons, HEB, Kroger, Rite Aid, and Walmart, to name a few. Anyone who wants to get their shot can call ahead to the pharmacy of their choice to find out about the available types of vaccines and make their appointment.

Will You Get Sick After a Flu Shot?

Yes, it is possible to feel ill after getting a flu shot. These symptoms include:

  • Headache
  • Nausea
  • Fever
  • Muscle Aches
  • Soreness
  • Swelling
  • Redness at the injection site

These symptoms are usually mild to moderate and resolve within a few days. However, several potential side effects signal a possible allergic reaction to the vaccine which could indicate the need for medical care. These include:

  • Hives
  • Paleness
  • Swelling around the lips and eyes
  • Increased heart rate
  • Dizziness
  • Difficulty breathing
  • Hoarseness
  • Wheezing

If you exhibit any of these symptoms after receiving a flu shot, seek medical care immediately.

What Other Vaccines Does Medicare Cover?

Medicare Part B and Medicare Advantage provide coverage for several other vaccines besides the flu shot. Some other notable vaccines available include those that protect against:

  • COVID-19: Medicare Part B pays for recipients to get the vaccine against the SARS-CoV-2 virus. This part will also pay for any boosters as they are released.
  • Hepatitis B: Hepatitis B is a liver infection caused by HBV, the Hepatitis B virus. Chronic hepatitis B can increase the risk of liver cancer, cirrhosis, and liver failure.
  • Pneumococcal Viruses: Pneumococcal disease is caused by the Streptococcus Pneumoniae bacteria. Infections can span from sinus and ear infections to bloodstream and pneumonia infections.

There are also several vaccines not covered by Original Medicare or Medicare Advantage but may be provided free of cost to those with Part D. These may include:

  • Tdap Vaccines: Tdap vaccines are a series of inoculations usually given together because they help protect against three important diseases: tetanus, diphtheria, and pertussis (whooping cough). Because those illnesses tend to happen at similar times of the year as the flu, providing them as one single course of treatment is common.
  • Shingles Vaccine: Shingles is a painful blistering rash caused by the chickenpox virus. Those that had chickenpox as children have the virus for shingles lying dormant in their system. Medicare Part D will cover the shingles vaccine because it is more likely to develop in older individuals, especially if they grew up before the chickenpox vaccine was developed.