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Is the Flu Shot Covered by Medicare?

If you’re someone who’s enrolled in Medicare, you’re likely within one of the demographics that’s considered at-risk of serious complications with the flu — the senior demographic.

Each year, hundreds of thousands of people are hospitalized due to influenza. You can lower your risk of severe complications from this illness by getting a flu shot each year. However, health care bills have a tendency of adding up, even for essential things. That’s why having health care coverage can be such a relief for beneficiaries. But, does Medicare cover flu shots?

Does Original Medicare Cover the Flu Shot?

We won’t hold you in suspense. The flu shot is considered such an important health care service for seniors and other Medicare beneficiaries that Medicare covers it entirely, as long as you fit the proper circumstances. In Original Medicare, this service is covered by Part B, which covers things like doctor’s visits, physical therapy, or preventive care.

The flu shot is considered such an important health care service that Medicare covers it entirely, as long as you fit the proper circumstances.

What are these circumstances? Medicare covers one flu shot per flu season. For most people, this is enough, since evidence points to more flu shots not having that much of a benefit, except in certain groups. This group is mostly in young children under the age of eight. The other condition is that you receive the shot from a qualified health care provider who accepts Medicare assignment. So, if you have Medicare and are getting your one flu shot for the flu season, and you’re getting it from a qualified provider who accepts assignment, you shouldn’t have any out-of-pocket cost!

Who Is a Qualified Health Care Provider?

So, what is a qualified health care provider in terms of a flu shot? Well, the obvious answer is your physician, but these aren’t the only professionals that fall under the term “qualified health care provider.” A qualified health care provider is generally a licensed professional who’s demonstrated expertise and education in their health care field and remains in good standing with their licensing board. This can mean it’s a registered nurse, a physician assistant, or a physical therapist, to name a few examples. The wide scope of the definition of a qualified health care provider allows you to get your shot from the most convenient location for you, whether that’s your doctor’s office or your local pharmacy.

A qualified health care provider is generally a licensed professional in good standing with expertise and education in their field.

As we mentioned above, it’s important that the health care provider accepts Medicare assignment. If the flu provider accepts assignment, that means they’ve agreed to be paid by Medicare for the shot. If the provider accepts assignment, you’ll have no out-of-pocket cost for the flu shot. If they don’t accept assignment, you may be required to pay for the shot in full or pay for it upfront and submit the bill to Medicare for reimbursement. That all depends on whether they’re non-participating or if they’ve opted-out. Either way, it always pays to verify whether a health care provider accepts Medicare prior to receiving any health care services.

Do Medicare Advantage Plans Cover the Flu Shot?

If you have a Medicare Part C (Medicare Advantage) plan, don’t worry, you should be covered as well. Since Medicare Advantage plans are required to cover at least what is covered by Original Medicare, a Medicare Advantage plan should offer some form of flu shot coverage that’s comparable to Original Medicare. Unlike Original Medicare, however, there may be some out-of-pocket costs, depending on the type of plan and where you get the shot from.

Unlike Original Medicare, however, there may be some out-of-pocket costs, depending on the type of plan and where you get the shot from.

For example, if you have an HMO or PPO, you may need to get your shot from within the plan’s network (in addition to meeting Medicare’s eligibility requirements) for it to be fully covered. If you get the shot outside of the plan’s network, you may have out-of-pocket costs, depending on the type of plan. In some cases, you may have to pay the entire bill for the flu shot (which could be under $50). In others, you may simply have to pay a copay or coinsurance. This varies depending on your plan, so it’s worth looking at the specifics if you’re a Medicare Advantage member.

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Getting an annual flu shot is important to staying healthy and keeping those around you from getting sick. Due to this importance, Medicare has made it as simple and pain-free as they can to help Medicare beneficiaries afford and receive the shot. If you don’t know where you can get a flu shot, check out the free Flu Vaccine Finder below, courtesy of the Centers for Disease Control and Prevention!