Does Medicare Cover the RSV Vaccine?
Medicare Part D covers the RSV shot, and there should be no copay or coinsurance.
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Medicare Part D covers the vaccine for RSV, or respiratory syncytial virus, and generally there’s no cost to you.
Here’s what you should know about Medicare and the RSV vaccine.
What is RSV?
RSV is a virus that comes with cold-like symptoms, like a runny nose, headache or sore throat. Symptoms are typically mild, but for some older adults, RSV can become very serious, leading to conditions like pneumonia or congestive heart failure. You could end up in the hospital, and as many as 10,000 older adults die of RSV complications each year, according to the American Lung Association.
Does Original Medicare cover the RSV vaccine?
Original Medicare doesn’t cover the RSV vaccine. However, if you have Medicare Part D prescription drug coverage, Part D will cover the RSV vaccine. And because this is a vaccine that’s part of recommended preventive care for older adults, there should be no cost to you.
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Medicare Advantage is an alternative to traditional Medicare offered by private health insurers. It covers the same benefits as Medicare Part A and Part B.
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- States available46 states and Washington, D.C.
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Does Medicare Advantage cover the RSV vaccine?
If you have a Medicare Advantage plan with prescription drug coverage, your plan’s drug coverage will cover the RSV vaccine. If your Medicare Advantage plan doesn’t offer prescription drug coverage and you have a standalone Part D plan, the RSV shot will be covered by your Part D plan.
» MORE: Best Medicare Advantage plans
Should you get the RSV vaccine?
The Centers for Disease Control and Prevention (CDC) recommends that all adults age 75 and older get the RSV vaccine, and adults age 60 to 74 get the RSV vaccine if they’re more likely to get seriously ill from RSV.
According to the CDC, you’re at a higher risk of getting seriously ill from RSV if you have chronic heart or lung disease, a weakened immune system, or live in a nursing home or another long-term care facility, among other things.
How often do you need the RSV vaccine?
A single dose of the RSV vaccine should protect you for about two winter seasons, if you time it right, according to the CDC.
For best results, aim to get your shot in the late summer or early fall.
What other vaccines does Medicare cover?
Medicare Part D covers vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP), including vaccines for shingles and whooping cough. If the ACIP recommends a vaccine, your drug plan will cover it at 100%.
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