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does medicare cover rsv vaccine

Does Medicare cover the RSV vaccine?

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Dear Connie,

I have a chronic illness and have heard that this latest round of flu or colds is getting worse, especially the RSV. I got my flu shot recently, and when I was there, they said I could also get my RSV vaccination. I wasn’t sure if Medicare covered it, so I passed. I’m curious: does Medicare cover the RSV vaccine?

Getting my shots,
Bobby from Carmel-by-the-Sea, California

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Dear Bobby,

Thanks for writing in to ask this question. I know that many people are curious about whether the RSV vaccine is covered.

Respiratory Syncytial Virus (RSV) is a respiratory virus that causes cold-like symptoms. Usually, RSV season begins in the fall and peaks in the winter. People who are 65 and older are at high risk of having serious complications from RSV, like a lung infection or pneumonia. You mentioned that you have a chronic illness. RSV can also lead to worsening serious conditions like asthma, Chronic obstructive pulmonary disease (COPD), and congestive heart failure.

Anyone 65 and older with chronic heart or lung disease, a weakened immune system, underlying medical conditions, or living in a nursing or long-term care facility is more at risk of developing a life-threatening condition. An average of 110,000 older adults are hospitalized every year, while an average of 8,000 die because of an RSV infection. Getting the RSV vaccination can protect you from getting RSV.

For adults aged 60 and older, two RSV vaccines have been approved by the Food and Drug Administration (FDA) and recommended by the Centers for Disease Control and Prevention (CDC). These are Arexvy by GSK and Abrysvo by Pfizer. You can check with your doctor about which is best for you.

The RSV shot is covered by Medicare. But maybe not like you would expect. Let me explain.

Medicare Part D prescription drug coverage covers the RSV shot – not Medicare Part A or Part B. Because the Advisory Committee on Immunization Practices (ACIP) recommends RSV vaccination, it’s covered by Medicare Part D plans. Medicare will cover the vaccine at no cost. You should not pay anything out-of-pocket, including deductibles, coinsurance, or copayments.

Agent tip:

“Because the ACIP recommends the RSV vaccine, it’s covered by Medicare prescription drug plans and should be covered at no out-of-pocket cost to you.“

You can get the RSV shot at your doctor’s office or local pharmacy.

Medicare Advantage plans cover everything that Medicare Part A and B do. However, your prescription coverage may vary. If you’re enrolled in a Medicare Advantage Prescription Drug plan, you should contact your plan to find out where you can get the RSV shot for there to be no out-of-pocket cost to you.

I hope that this information has helped you understand RSV vaccination coverage. Should you have questions about plans or want to speak with a local licensed agent—call (623) 223-8884. We’re here to support you throughout your Medicare journey.

Curious if Medicare covers the shingles vaccine? We’ve also responded to that question: Does Medicare cover the shingles vaccine?

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Frequently Asked Questions

Does Medicare Part B cover RSV vaccine?
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No, Medicare Part B does not cover the RSV vaccine. Instead, the RSV vaccination is covered by Medicare Part D and Medicare Advantage Prescription Drug plans. This is good news because when a vaccine is covered by a prescription drug plan, then there is no out-of-pocket cost to you. You will not need to meet a deductible or pay a copayment to get the RSV vaccine.

Does Medicare cover RSV vaccine for seniors?
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Yes, Medicare Part D prescription drug plans and Medicare Advantage Prescription Drug plans cover the RSV vaccine for seniors. The RSV shot should have no out-of-pocket costs, such as a deductible or copayment because it is recommended for all people over 60 by the Advisory Committee on Immunization Practices (ACIP).

Does Medicare Part D cover RSV vaccine?
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Yes, Medicare Part D covers the RSV vaccine, and so do Medicare Advantage Prescription Drug plans. The RSV vaccine should be free with your prescription drug plan because it is recommended for all people over 60 by the Advisory Committee on Immunization Practices (ACIP).

Does Medicare Advantage cover RSV vaccine?
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Yes, most Medicare Advantage cover the RSV vaccine. However, it’s only covered under the prescription drug plan portion of a Medicare Advantage Prescription Drug plan. This is because neither Medicare Part A nor Part B covers the RSV vaccine, so standard Medicare Advantage plans may not either. You should check with your Medicare Advantage plan to ensure the RSV vaccine is covered by your Medicare Advantage Prescription Drug plan and where you can get the injection (doctor’s office or pharmacy).

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