Does Medicare Cover Flu Shots?

Believe it or not, flu season is upon us already. As soon as the seasons change from summer to fall, it's time to think about how to better prepare yourself for the increased risk of contracting the flu. With fall officially starting on September 22nd, there's no better time than now to make those preparations so you can better combat this year's batch of influenza viruses. But where do you begin, especially if you have Medicare?

While Medicare sounds like it'd be a straightforward healthcare plan for those above the age of 65, the truth is that there are many options and moving parts that can make navigating the world of Medicare coverage a little difficult. Think about it: Part A, Part B, Part C, Part D, Medicare supplement insurance, Original Medicare, Medicare Advantage... Clearly, Medicare is not a one-size-fits-all concept. It's a lot more multifaceted than that.

As such, it's worth discussing whether Medicare recipients are covered when it comes to their annual flu shot. Does it vary from plan to plan? Are there any plans that charge recipients for the flu vaccine? Is one plan better for flu shots than another? These questions are all perfectly valid, and thankfully, there are answers to them and any other questions you might have about whether Medicare covers flu shots. Simply read on to learn more.

How Does the Flu Shot Work?

The flu shot is an important aspect of maintaining good health throughout cold and flu season, particularly if you are at risk of getting very ill from the flu. Influenza, once contracted, has the potential to get incredibly serious, very fast — potentially leading to hospitalization and even death in severe cases. While the influenza viruses vary from year to year, the one thing that remains consistent is the millions who end up sick from it, the hundreds of thousands who end up in the hospital from it and the tens of thousands who die from flu-related symptoms annually.

Because the flu viruses are constantly mutating in an attempt to be more contagious, the flu shot's efficacy varies anywhere from 40 to 60 percent each year. It works by introducing a weak strain of the virus to the body to teach the immune system how to fight back against it and create antibodies that will better protect the body from that year's strains. Experts design each year's flu shot based on what research indicates will be the season's most common threats. Additionally, the flu shot is quadrivalent, which means it will protect you from an influenza A(H1N1) virus, an influenza A(H3N2) virus, and two influenza B viruses.

When Do Flu Shots Become Available Each Year?

Typically, annual flu shots start to arrive at doctors' offices and pharmacies in August of each year. Depending on the severity of the strain in a given year, the flu shot has been known to stay available at pharmacies from August all the way through to May of the following year. Of course, it needs to be said that you should not wait until May to get your flu shot — typically, flu season is winding down around this time and has likely already seen its peak months before May. With that being said, even a late shot is better than no shot at all.

What Do Flu Shots Cost Without Insurance? 

Without insurance of any kind, an annual quadrivalent flu shot will probably cost you somewhere between $30 and $40 depending on the pharmacy. Some will be more, some will be less, but the $30 to $40 range seems pretty typical on average. People over the age of 65 also have access to a high-dose flu shot, designed to offer more protection for longer for those with naturally weaker immune systems because of their age. Without insurance, these high-dose shots will cost as much as $70.

Are Flu Shots Covered by Medicare?

If you have Original Medicare, you can rest easy knowing that Medicare Part B completely covers the cost of one flu shot per season. That's right: the flu shot is free under Medicare Part B. The same goes for those of you who fall under Medicare Advantage — the flu shot is also covered completely for you. As long as your doctor or pharmacy accepts Medicare assignments and you're properly enrolled and eligible, you ever won't have to pay a cent to get your ever-important flu shot. As such, there's no excuse not to get it. (It's worth mentioning that there are exceptions to the rule, such as those of you who suffer from an allergy to one of the flu shot ingredients or have been diagnosed with Guillain-Barré Syndrome before. If you're concerned, talk to your doctor or pharmacist to learn more about this rare exception.)

When Should You Get the Flu Shot? 

If you're above the age of 65, you are medically categorized as high-risk. Statistically , people in this age group have a higher chance of contracting illness because of the body's naturally weakened immune system above the age of 65. It's essential that you get the flu shot at the right time of year for maximum effectiveness. Get vaccinated too early, and your shot might wear off before the height of the flu season — typically November, December and January. Get vaccinated too late, and your shot might not reach its peak efficacy before the season gets bad. Ideally, the perfect time for people 65 and older to get the shot is September or October, but no later than Halloween.

Where Can You Get a Flu Shot?

Flu shots should be available at your local pharmacy, at your primary care provider's office and even inside your local grocery store or retailers like Target and Walmart. Thankfully, the CDC anticipates no supply chain disruptions of any sort this flu season, so flu shot availability shouldn't be a problem whatsoever.

Are There Side Effects to the Flu Shot?

As with any sort of medicine, there are the occasional side effects to the flu shot. These may include:

• Soreness, redness or swelling at the site of the shot.

• Muscle aches.

• Headache.

• Nausea.

• Fever.

If you're concerned about how the shot may negatively affect you, speak to your doctor about options specifically for you. If you experience any of the following in the minutes or hours after your flu shot, you may be suffering a rare allergic reaction:

• Difficulty breathing

• Hives or rashes

• Swelling of the eyes or lips

• Hoarseness or wheezing

• Dizziness

• Paleness

If any of these symptoms are present, seek medical attention immediately.

The Bottom Line: Making Sure You’re Covered for Your Flu Shot

When all is said and done, now that flu season is officially upon us, it's incredibly important for Medicare recipients to make sure they're covered for their annual flu shot. Now that you know they're available for free under Medicare — both Original Medicare and Medicare Advantage — it's imperative for you to visit your primary care provider or your local pharmacy to get scheduled for your flu shot sooner rather than later. Ideally, stick to the window discussed above (between September and October) for optimal effect. Speak with your doctor or the pharmacist to determine the time and date that works best for you.

If you have any further questions about your insurance and what it does and doesn't cover, consider reaching out to the individuals at PolicyScout. Given PolicyScout's proven expertise in the insurance industry, it's worth getting in touch to discuss your Medicare coverage with someone who knows exactly what they're doing. Medicare can be tricky to navigate, which makes the help of an expert at PolicyScout invaluable. Contact PolicyScout for a quote today, or visit PolicyScout's website to survey provider reviews for various Medicare supplement plans.