Does Medicare cover the RSV vaccine?

What does Medicare cover for the RSV vaccine?

Medicare drug coverage (Part D) covers the RSV vaccine. RSV vaccines can protect you from getting RSV, a respiratory virus that causes cold-like symptoms.

Medicare drug coverage must cover all commercially available vaccines, like the RSV vaccine, when medically necessary to prevent illness. Part D covers all adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) that aren't covered under Medicare Part B, including vaccines for shingles, whooping cough and measles.

Who is at high risk for RSV?

Certain medical conditions and factors increase the risk for severe RSV. Talk to your doctor or other health care provider to find out if you may be at increased risk. Medicare.gov says these adults are at high risk of having serious health complications from RSV:

• Adults 75 and older
• Adults between 50 and 74 with certain conditions

What do I pay for the RSV vaccine?

You pay nothing for the RSV vaccine if you have Part D. Your Part D plan won't charge you a copayment or deductible for vaccines that ACIP recommends.

Where can I get the RSV vaccine?

You can get RSV vaccines in many places, including your doctor's office and your local pharmacy. If you have a Medicare Advantage Plan, contact your plan to find out where you can get the RSV vaccine.

Medicare.gov says it's safe to get the flu vaccine with other vaccines, like the COVID-19 and RSV vaccines. Medicare Part B covers the flu and COVID-19 vaccines; see Medicare coverage of flu shots.

How do I get Part D coverage for the RSV vaccine?

You get Medicare drug coverage by joining a Medicare-approved plan that offers drug coverage. Medicare drug coverage is available to anyone with Medicare, and you have 2 options:

• A separate Medicare drug plan, which adds drug coverage to Original Medicare. You must have Part A and/or Part B to join one.
• A Medicare Advantage Plan (Part C) or other Medicare health plan that includes drug coverage. Most Medicare Advantage Plans include drug coverage (Part D).

Does Medicare Advantage or Medigap change this?

Medicare Advantage Plans that include drug coverage will also cover drug benefits like the RSV vaccine. If you join a Medicare Advantage Plan that doesn't offer drug coverage, in most cases you won't be able to add a separate Medicare drug plan.

Medigap (Medicare Supplement Insurance) plans sold after 2005 don't include prescription drug coverage. If you have Medigap and want drug coverage, you can join a separate Medicare drug plan (Part D). See how Medicare covers prescription drugs.