Influenza poses a significant health risk for older adults, often leading to severe complications and hospitalization. The annual flu shot is a powerful tool for protection. Yes, Medicare covers the flu shot, ensuring beneficiaries can receive the necessary immunization each flu season.
How Medicare Part B Covers the Flu Shot
Coverage for the seasonal influenza vaccine is provided primarily through Medicare Part B, the component of Original Medicare designated for medical insurance and preventive services. The Centers for Medicare & Medicaid Services (CMS) classifies the flu shot as a preventive benefit. This designation dictates the cost structure for beneficiaries.
As a preventive service, Medicare Part B covers one flu shot per flu season at 100% of the Medicare-approved amount. Beneficiaries pay nothing out-of-pocket, as there is no deductible or copayment applied to the vaccine or its administration. This zero-cost structure is upheld as long as the provider accepts Medicare assignment. Coverage is based on the flu season, which typically runs from late summer through the spring of the following year.
Medicare Part B may also cover a second flu shot in the same season if a physician deems it medically necessary, though typically only one annual shot is recommended. High-dose or specialized vaccines designed for people 65 and older, such as Fluzone High-Dose or Fluad, are also covered under the zero-cost terms.
Finding Approved Providers for the Shot
Beneficiaries have several convenient options for receiving the immunization under Medicare Part B. Approved locations include your primary care physician’s office or other medical clinics.
Many retail pharmacies, such as major chains, also participate and are authorized to administer the shot and bill Medicare directly. Local health departments and specialized flu clinics often serve as approved providers. To maintain the zero-cost benefit, confirm that the provider accepts Medicare assignment beforehand. This signals the provider agrees to the Medicare payment rate and will not bill the beneficiary.
Coverage Under Medicare Advantage and Part D Plans
Beneficiaries who choose a Medicare Advantage Plan (Part C) have the same right to a zero-cost flu shot. Advantage plans are required by law to offer at least the same level of coverage as Original Medicare, including all preventive services. Part C plans must cover the annual flu shot at no cost.
Advantage plans are managed by private insurance companies and typically use a specific network of providers. While the cost remains zero, beneficiaries may be required to get the shot from an in-network doctor or pharmacy. Using an out-of-network provider could result in an unexpected charge, so confirming network status beforehand is advisable.
Medicare Part D, which covers prescription drugs, typically does not cover the flu shot because Part B already provides coverage. Part D covers other vaccines, such as the shingles or respiratory syncytial virus (RSV) vaccines, and any antiviral medications needed to treat the flu.