Will Medicare Cover the Flu Shot?
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Medicare covers the full cost of yearly flu shots. To get the shot for free, be sure to use a provider that accepts your plan's payment, whether you're enrolled in Original Medicare or a Medicare Advantage plan. You must use a plan provider if you have a Medicare Advantage HMO, but PPO members are covered for both in-network and out-of-network flu shots.
If a second flu season breaks out in the same calendar year, your doctor may recommend you get a second shot. Both Original Medicare and Medicare Advantage plans cover a second vaccine if your doctor approves it.
Since the flu vaccine is free with Medicare, the main difference between plans is where you can get the shot. You won't be charged for the shot as long as you use a provider covered by your plan.
Does Medicare pay for flu shots?
Medicare pays for the full cost of one flu shot each year. You don't need a doctor's approval, and you can get your shot from any health care provider or pharmacy that accepts Medicare.
Medicare may cover a second flu shot during the calendar year. This could happen if there are two separate flu seasons in the same year and your doctor recommends a second vaccine.
Starting in 2023, Medicare will expand its vaccine coverage to provide free vaccines for shingles and other conditions, similar to its free flu shots.
Does Medicare Advantage cover flu shots?
Medicare Advantage plans cover flu shots the same way as Original Medicare. You can get a free flu vaccine once per calendar year from any provider covered by your plan.
You don't need a referral to get an annual flu vaccine, even with a Medicare Advantage HMO.
If there are two flu seasons within the same calendar year, Medicare Advantage plans cover a second vaccine if your doctor approves it.
To be sure you're covered, contact your Medicare Advantage plan to find out where you can go for your flu shot. With an HMO, for example, you need to stay within your plan's provider network. If you have a PPO, you can go to an out-of-network provider and still get the shot for free.
Choosing a Medicare Advantage plan
If you're shopping for a Medicare Advantage policy, flu vaccines should not be part of your decision since coverage is similar among plans. But a plan's overall performance and Medicare rating may be important to you.
Company | Medicare rating | |
|---|---|---|
| Kaiser Permanente | 5.0 |
| AARP/UnitedHealthcare (UHC) | 4.4 |
| Blue Cross Blue Shield | 4.2 |
| Humana | 4.1 |
| Aetna | 3.8 |
| Cigna | 3.5 |
When should I get a flu shot?
According to the Centers for Disease Control and Prevention (CDC), younger people can get the flu shot as early as July or August. But for older adults, getting the vaccine too soon can reduce its effectiveness later in the season.
If you're 65 or older, the CDC recommends getting the vaccine in September or October, before the flu begins to spread. But you can still be protected even if you get the vaccine in November or later.
Medicare covers the vaccine at any time during flu season.
Facts about the flu and flu vaccines
You could pay up to $130 in out-of-pocket costs to treat the flu, while the vaccine is free.
It takes two weeks for the flu vaccine to take effect, so get your shot early!
It’s safe to get the flu vaccine along with others, like the pneumonia vaccine.
The vaccine is especially important for seniors, who tend to get sicker compared to younger adults.
The flu shot is the best way to prevent getting sick or being hospitalized with the flu.
Flu vaccine safety
- You won't contract the flu from the flu vaccine.
- You can't get autism from the flu vaccine.
Frequently asked questions
Does Medicare cover flu shots at 100%?
Yes, Medicare covers flu shots at 100%. You pay nothing out of pocket as long as your provider accepts Medicare payment as payment in full.
How do Medigap plans cover flu shots?
Medigap policies are designed to pay charges left over after Medicare pays. Since Original Medicare covers the flu shot in full, you don't need your Medigap plan to help pay for it.
Does Medicare pay for flu and pneumonia shots?
Yes, Medicare pays the full cost of flu and pneumonia shots. And it's safe to get both vaccines at once, which could save you a second trip to your doctor or pharmacist.
Methodology
Medicare Advantage plan coverage is from AARP/UnitedHealthcare, Aetna, Blue Cross Blue Shield, Cigna, Humana and Kaiser Permanente. Original Medicare coverage for flu vaccines is from Medicare.gov and CMS.gov. General flu-related guidance is from CDC.gov.
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