Does Medicare cover flu shots? | BCBSKS

The Centers for Disease Control and Prevention (CDC) recommends that everyone aged 6 months and above get a flu shot. Flu shots provide strong protection against multiple strains of seasonal influenza, and the 2022 flu season is expected to be particularly bad due to post-pandemic increased social mixing and lack of mandated protective measures such as masking.

The flu shot can not only lower your risk of catching the flu, but if you do get sick, it can lower your risk of hospitalization and even death. This is especially important for those in high-risk groups, including those who are over age 65, have an underlying health condition, or are pregnant. But flu shots are important for everyone.

Does Medicare pay for flu shots?

The simple answer is yes. To understand Medicare flu shot coverage, let’s take a brief look at the four different parts of Medicare.

Medicare is a government-sponsored health insurance program that covers people over age 65 and younger people with certain qualifying disabilities. Parts A and B are known as original Medicare, while Parts C and D are add-ons available through private insurance companies such as Blue Cross and Blue Shield of Kansas.

Medicare Part A is hospitalization insurance, which also covers hospice care and some skilled nursing or in-home care. It’s free for everyone once you turn 65 or qualify due to a disability, as long as you previously worked and paid Medicare taxes.

Medicare Part B is medical insurance. This covers doctor’s visits, preventive healthcare, and similar services. It is the part of Medicare that covers flu shots. You will become eligible for Part B at the same time as Part A, but Part B requires you to opt in and pay a small premium. There is a low deductible, but it does not apply to flu shots. As long as you have Medicare Part B, your flu shot is covered at 100%.

Medicare Part C is also known as Medicare Advantage. This is wraparound coverage designed to plug the gaps in original Medicare coverage. Medicare Advantage plans are required by law to offer everything available through original Medicare, but these plans typically go much further.

Medicare Part D provides prescription drug coverage. Standalone Part D plans are available, but many Medicare Advantage plans also include this coverage.

How much is a flu shot without insurance?

The cost of a flu shot with no insurance varies by region and provider, but is typically around $40 to $50 at a pharmacy. High-dose vaccines, recommended for those aged 65 and above, may cost closer to $100. But if you have Medicare Part B, you won’t pay a cent. In addition, many hospitals, employers, and even cities host free flu shot fairs at some point just before or during flu season.

How often does Medicare cover flu shots?

Medicare will pay for one flu shot per year. You can typically get your shot at any time during one flu season, and then at any time during the next, even if a full 12 months have not elapsed. So if you got last season’s shot in January, and this season’s shot in October, Medicare will generally pay, as long as the shots are in two separate flu seasons.

Where can I get a covered flu shot?

You can get your Medicare flu shot at any place that accepts Medicare assignments. This includes major national pharmacies such as Walgreens and CVS, many smaller pharmacies, and your doctor’s office. If you’re unsure, simply ask before you receive the shot whether it will be covered by Medicare.

How should I prepare for my flu shot?

Flu shots are simple and easy, and side effects are generally mild. You might experience some soreness at the injection site, as well as some slight body aches or minor fever in the hours after your shot. But Louisiana’s Ochsner Heath has some pro tips that can help you come through like a champ:

  • Drink lots of water. Hydrating well before and after the shot helps relax your muscles and move the medication quickly through your system.
  • Choose your arm. It’s best to keep your shot arm moving throughout the day, making your dominant arm a great choice. But if you do a lot of physical work with that arm, you could really feel the soreness. In that case, you might prefer your non-dominant arm.
  • Relax. The more relaxed your arm is, the less you’ll feel the shot going in. Take a deep breath and drop your shoulder right before your vaccine.
  • Take a pain reliever. It’s best not to take pain medication before your shot (unless it’s part of your treatment plan for an existing condition). But if soreness, fever, or a general feeling of unwellness sets in after the shot, take a Tylenol or Advil for some relief.

What types of flu shots are available?

There are many different flu vaccines, and one is not preferentially recommended over another for most people. However, there are a few caveats:

  • The nasal mist flu spray is only approved for those ages 2 to 49 without certain underlying medical conditions.
  • People aged 65 and above should get one of the high-dose flu shot options.
  • Those with an allergy to eggs should get one of the egg-free options. One is approved only for adults, while the other is available for anyone aged 6 months or older.

Do I need more than one flu shot?

Most people need only a single flu shot each year. However, kids ages 6 months to 8 years should get two doses, four weeks apart, the first time they are vaccinated. If your kids are in this age group and have previously received a single-dose flu shot, ask their doctor if two doses are recommended this year.

Who should not get a flu shot?

Flu shots are recommended for nearly everyone. But there are three groups that should not get vaccinated:

  • Children younger than 6 months of age.
  • People with a severe, life-threatening allergy to any component of the vaccine other than eggs. Those with an egg allergy should get an egg-free option, preferably in a healthcare facility such as your doctor’s office or a local hospital.
  • Those who are actively sick with severe symptoms of any illness. Wait until you recover and then get your shot.

If you fall into one of the groups below, talk to your doctor before getting a flu shot:

  • Severe allergic reaction to a previous flu shot.
  • History of Guillain-Barré Syndrome.
  • Mild to moderate symptoms of current illness.

What are some symptoms of the flu?

The flu is a respiratory illness that can cause a range of symptoms. These include, but are not limited to:

  • Body aches
  • Congestion
  • Coughing
  • Fatigue
  • Fever
  • Runny nose
  • Sneezing

Having the flu can increase your risk of other medical conditions, from dehydration to sinus infections to bacterial pneumonia. It can also worsen any underlying conditions you have such as asthma or diabetes.

Does Medicare cover flu treatments?

It depends. The first line of defense against an existing case of the flu is typically an antiviral medication. These pills work best when started within two days of developing flu symptoms. It’s important to get tested right away, especially since flu symptoms are similar to Covid-19 symptoms, but the antiviral medications are different for the two diseases. Original Medicare does not cover prescription drugs, including antiviral pills. But you may be covered if you have Medicare Part C or D.

If you visit a healthcare facility, your visit will be covered under normal Medicare Part B rules and copays, unless you have a Medicare Advantage plan with additional coverage. Likewise, Medicare Part A rules will apply if you are hospitalized with the flu, except if you have a Medicare Advantage plan that offers additional benefits.

To learn more about how a Medicare Part C (Medicare Advantage) plan can help plug the gaps in original Medicare coverage, call Blue Cross and Blue Shield of Kansas today at 866-627-6705.

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