The seasonal flu, historically, is far more serious for seniors over the age of 65, especially for those on fixed incomes with pre-existing serious medical conditions such as diabetes and heart disease. This underscores the importance that a seasonal flu shot be a financially viable option while also being readily available to all qualified Medicare enrollees. Fortunately, Original Medicare Part B, which covers doctor’s visits and outpatient care includes the cost of the flu shot for Medicare beneficiaries once per year in the fall or in the winter. For those patients who are on Original Medicare, the flu shot is provided one time per flu season.
Does Your Healthcare Provider Have to Accept Medicare Assignment to Have Medicare Cover the Flu Shot?
Your flu shot is fully covered by Medicare if you are currently enrolled and the healthcare provider that administers the shot accepts Medicare payments also known as Medicare assignment.
Does the Part B Deductible Apply to the Flu Shot?
The Medicare Part B Deductible for 2022 is $233, which means that this is the amount you must normally pay first out-of-pocket for outpatient medical services. Once this amount is paid, you are only responsible for paying the 20% not covered by Medicare for an outpatient medical service.
The good news is that the Part B Outpatient Medical Services Deductible is not applicable when receiving your flu shot and so does not have to be paid before you get your flu shot, meaning that the flu shot should come at no cost to the Medicare enrollee.
Do Medicare Advantage Plans Cover the Flu Shot?
Medicare Advantage Plans provide all the benefits of Medicare Parts A and B along with prescription drug coverage for those who are eligible for Medicare. Medicare Advantage Plans do cover the flu shot one time per flu season. If the Medicare Advantage Plan does have a deductible, just like with Original Medicare, the deductible will not apply to the flu shot.
How Much Does Medicare Pay for the Flu Shot?
The Medicare Approved Amount for a flu shot for 2021 to 2022 varies from $10 to $66 depending on the brand and type of flu vaccine administered.
In addition, Medicare will pay for two flu shots if this is deemed medically necessary by your health care provider. A medically necessary scenario may occur if the patient has either a weakened or a compromised immune system that requires an additional flu shot for added protection, lowering the risk of hospitalization from a severe case of the flu.
Does Medicare Cover the Flu Shot at Pharmacies?
Medicare does cover the flu shot given at many pharmacies such as CVS and Walgreens.