Does Medicare Cover the Flu Shot?

QUESTION: Does Medicare cover the flu shot?

Ryan Answers: Medicare Part B covers immunizations for influenza (the flu), pneumonia and hepatitis B. For most people, this is where immunizations covered by Part B stop. Medicare Part B will, however, cover other immunizations if you’ve been exposed to a dangerous virus or disease. If your doctor determines that you need a tetanus shot or even a series of rabies shots after a potential exposure, they will also be covered by Part B.

If you have Medicare Part D, you can get coverage for any commercially available vaccine that is not covered by Part B. All Part D plans must include all commercially available vaccines on their formularies. If you need a shingles shot (Zostavax), your Medicare Part D plan will pay for both the shot and the administration of the shot. Be sure to check with your Part D plan for coverage details and to see where you should get you shot.

Now that we know a little more about how Medicare’s immunization coverage works let me make an urgent public service announcement: Please take time to get your flu shot again this year! Influenza is often quite serious for people 65 years and older due to the high risk of complications. What starts off as the flu can quickly start a downward spiral ending in hospitalization and even death.

How do flu vaccines work?
Flu vaccines cause antibodies to develop in the body about two weeks after vaccination. These antibodies provide protection against infection with the viruses that are in the vaccine. The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season.

When should I get vaccinated?
Flu vaccination should begin soon after vaccine becomes available, if possible by October. However, as long as flu viruses are circulating, vaccination should continue to be offered throughout the flu season, even in January or later.

Does flu vaccine work right away?
No. It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against influenza virus infection. That’s why it’s better to get vaccinated early in the fall, before the flu season really gets under way.

Can the flu vaccine give me the flu?
No, a flu vaccine cannot cause flu illness. Flu vaccines that are administered with a needle are currently made in two ways: the vaccine is made either with flu vaccine viruses that have been “inactivated” and are therefore not infectious or with no flu vaccine viruses at all (which is the case for recombinant influenza vaccine).

The flu shot: The viruses in the flu shot are killed (inactivated), so you cannot get the flu from a flu shot. Some minor side effects that may occur are:

• Soreness, redness or swelling where the shot was given
• Fever (low grade)
• Aches

Sources: Centers for Medicare & Medicaid Services, Centers for Disease Control & Prevention

Ryan Vlasin Pharmacy Director

Confused about your Medicare Part D Prescription Drug coverage? Ask the Medicare MarketPlace® pharmacist! Email your question to Pharmacy Director Ryan Vlasin at: pharmacist@insuractive.com .