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Does Medicare Cover Flu Shots ?

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It won’t be more than 3 months or so before the flu season is on us again, and possibly with a second wave of Covid-19 as well. So, this winter, it is very important that our elderly loved ones get their flu shots so that they at least have some protection.

Medicare Part B will cover one flu shot per season, if your doctor or other qualified health care provider are Medicare-enrolled and accept assignment, meaning the Medicare-approved price, and you will pay nothing as there is also no deductible for flu shots.

What exactly is the flu ?

 

Flu is a highly contagious respiratory illness caused by Influenza Viruses.

The seasonal flu outbreaks – November to April – are caused by Influenza viruses A and B.

Those who are at the greatest risk of serious health complications from the flu, are the elderly, young children under the age of 5 and people with certain underlying health conditions.

People with flu can give it to people up to six feet away when they talk, cough or sneeze.

It may also be possible, but with a lesser frequency, to catch flu by touching a surface with the virus on it, and then touching the nose or mouth.

In the first 3 -4 days of the illness people are at their most contagious. 

Typically though, it is thought an adult may be able to infect other people from the day before the flu manifests itself, and for another 7 days, so you can infect others even before you know you are sick.

To find out more, you can look on the Centers for Disease and Prevention website here.

Why should the elderly get flu shots ?

 

Each year in the United States, 9 out of 10 flu-related deaths and 6 out of 10 flu-related hospital stays occur among people aged 65+. An annual flu shot is one of the best preventive measures to help protect against the flu. The shot is available in both a regular strength dose and a high dose that provides extra immunity, which is often recommended for older adults.

The source of the text is the NCOA Center for Benefits access – “Vaccines: What Medicare pays for” which you can find and read here. The text is in a PDF file, so you will also be able to download it if you wish to.

The statistics above make a compelling argument for flu vaccination for the elderly community.

As you get older, your immune system is less able to defend your body against infections and viruses.

This means that the older you are, the more likely you are to catch the flu if you come into contact with people who are infected.

And the older you are, the more likely you are to develop serious complications from the flu, such as pneumonia.

I actually have had pneumonia and spent 9 days in intensive care, and those really were the worst 9 days of my life. I was only 30 years old, and I came extremely close to dying, so for an elderly adult it is very dangerous indeed.

Over 65’s who have underlying medical conditions are at even greater risk of having serious complications from catching the flu, such as pneumonia.

 

The medical conditions which put you at greater risk include –

 

  • asthma or COPD
  • heart disease
  • diabetes
  • liver or kidney disease
  • a compromised immune system

 

An immune system can be compromised by different types of cancer treatment, HIV/AIDS, steroids and other forms of anti-inflammatory treatments.

It is important to get the vaccine each year, as the flu virus mutates and previous vaccines may no longer be effective the following season.

By getting a flu shot you are not only protecting yourself, but you are protecting those around you, and this is why it is important for caregivers and children and grandchildren of elderly adults to get the vaccine each year.

If you would like to see the costs of the different flu vaccines if you actually had to pay for them, there is a list of the prices for the 2020-2021 flu season, on the Center for Medicare and Medicaid Services which you can find here.

The flu vaccine price ranges from $9.58 – $61.00 depending on the vaccine.

What are the different types of flu vaccine ?

 

The main types of Influenza Vaccines available to adults are –

 

  • Quadrivalent Influenza Vaccine – protects against 4 different viruses
  • High-Dose Flu Vaccine – 4 times more antigen as a regular shot
  • Intradermal Influenza Vaccine – into skin instead of muscle
  • Adjuvanted Vaccine – made with additive fro stronger immune response
  • Cell-based Flu Vaccine -grown in cultured cells of mammalian origin
  • Recombinant Flu Vaccines – made with a method not using eggs
  • Nasal Spray Vaccine – live vaccine in a nasal spray

 

The vaccines which are recommended for the over 65’s are –

 

  • High-Dose Flu Vaccine
  • Adjuvanted Vaccine

 

If you wish to find out more I took this information from the Centers for Disease and Prevention website here.

 

Does Medicare pay for flu shots at a pharmacy ?

 

As I said at the very beginning –

Medicare Part B will cover one flu shot per season, if your doctor or other qualified health care provider are Medicare-enrolled and accept assignment, meaning the Medicare-approved price, you will pay nothing.

So in the case of a pharmacy, if the pharmacy is Medicare-enrolled (the pharmacy has the role of supplier here), and the health care worker giving the shots is Medicare-enrolled, Medicare will cover you for the flu shot – but only one flu vaccine per flu season (the season is November to April).

Do check that the Pharmacy is Medicare-enrolled and that they accept assignment, as this means that you will be covered for the whole cost.

With the flu vaccine you do not have to pay your deductible, and if the pharmacy accepts assignment you do not have to pay any coinsurance.

In most cases the pharmacy will bill Medicare directly.

 

Does Medicare pay for flu shots at Walgreens ?

 

Medicare Part B does cover flu shots at Walgreens.

 

You must – 

 

  • be enrolled in Medicare Part B
  • have had no flu shots before in that particular flu season

 

Walgreens is Medicare-enrolled and will simply bill Medicare for you for the flu shot, and there will be no deductible or coinsurance for you to pay.

Does Medicare pay for flu shots at Walmart ?

 

Medicare Part B does cover flu shots at Walmart.

 

You must – 

 

  • be enrolled in Medicare Part B
  • have had no flu shots before in that particular flu season

 

Walmart is Medicare-enrolled and will simply bill Medicare for your flu shot, and there will be no deductible or coinsurance for you to pay.

 

Does Medicare pay for flu shots at CVS ?

 

Medicare Part B does cover flu shots at CVS.

 

You must – 

 

  • be enrolled in Medicare Part B
  • have had no flu shots before in that particular flu season

 

CVS is Medicare-enrolled, and they will bill Medicare for your flu shot, and there will be no deductible or coinsurance for you to pay.

 

Does Medicare cover pneumonia shots ?

 

The Pneumococcal (pneumonia) vaccine is covered by Medicare Part B.

 

Pneumococcal bacteria infection can cause a number of different illnesses –

 

  • ear infections
  • sinus infections
  • pneumonia
  • meningitis

 

Medicare Part B pays for one pneumococcal vaccine, and if you visit a provider who is Medicare-enrolled, and who accepts assignment, there is no co-pay.

It is recommended by the Centers for Disease Control and Prevention that all adults over 65 get the pneumococcal vaccine.

Typically, a person will only need the pneumococcal vaccine once, but if they have certain underlying health conditions they may get it once every 5 years.

Younger people with certain underlying health conditions and chronic health conditions should get the vaccine as well.

The pneumococcal vaccine can be given at the same time as the flu vaccine.

If you wish to read more about the vaccines available you can find more on the Centers for Disease Control and Prevention website here.

What vaccines are covered by Medicare ?

 

The Influenza vaccine is covered by Medicare Part B – Medicare pays for one flu shot every flu season (the season is from November to April). Additional flu shots may be covered if it is considered medically necessary.

The Pneumococcal (pneumonia) vaccine is covered by Medicare Part B – Medicare pays for one shot, and it is recommended for all adults over the age of 65, and also younger adults with chronic health conditions.

The Hepatitis B Vaccine is covered by Medicare Part B – Medicare pays for a series of three shots for high or medium risk individuals.

If you have Medicare Part B, you pay no co-pay as long as the health care provider for the Hepatitis B Vaccine accepts assignment.

The Shingles Vaccine is covered by all Medicare Part D plans – Part D plans pay for shingrix which is recommended for adults over the age of 60.

The vaccine called Zostavax was removed from in the US on the 1st of July 2020.

Each Medicare Part D plan is different and the amount to which they cover the Shingles Vaccine will vary, and so will the amounts of the co-pay.

If you have a Part D plan, you will have to check with the plan to find out the rules for administration and for payment.

Some Medicare Advantage or Part C plans may also cover the Shingles Vaccine, and some cover both of the Tetanus booster vaccines.

The Tetanus Vaccine is covered by Medicare Part B and Part C  when it is for an injury or an illness and is “medically necessary”, otherwise it is covered by Medicare Part D plans – it is a booster for adolescents and adults (as a child you get the DTaP) and is for tetanus, diphtheria and pertussis (whooping cough).

With Medicare Part D, the cost of Tdap and Td Vaccines will depend on the Medicare Part D plan that you have signed up to, and they are all different, so you will need to check with your provider.

 

In general, other than the Influenza, Pneumococcal, and Hepatitis B Vaccines, Medicare Part D plans cover the commercially available vaccines for other diseases.

The exception to this I mentioned above was that some Medicare Advantage plans offer a shingles vaccine.

The amount of coverage and the co-pays you will have, will depend on the plan you have joined.

What exactly is the Hepatitis B Vaccine ?

 

Hepatitis B is a disease is spread by the hepatitis B virus, which affects the liver and which is generally spread through bodily fluids.

Not all cases of hepatitis B are serious, some are mild and last only a couple of weeks, although it can cause a far more severe illness which can stay with you for the rest of your life.

The mild form of hepatitis B is called “Acute Hepatitis B Infection”.

The chronic form of hepatitis B is called “Chronic Hepatitis B Infection”.

In the chronic form, the virus stays in the person’s body and can lead to cirrhosis of the liver, and cancer, and unfortunately death.

People with the chronic form can spread the hepatitis B virus to others.

The disease is more dangerous for certain individuals who may have other health conditions.

 

The high and medium risk categories include individuals with

 

  • hemophilia
  • end stage renal disease
  • diabetes
  • chronic conditions which compromise the body’s resistance to infection

 

If you are in one of these categories, you should consult with your health care provider to find out if you need to get the Hepatitis B Vaccine.

To get the full protection, you need the series of three shots against the virus.

If you want to find out more about the Hepatitis B Vaccine, you can got to Centers for Disease Control and Prevention and read about it here.

 

What is the Shingles Vaccine ?

 

Shingles is caused by the same virus that causes chickenpox – the varicella-zoster virus. 

After you’ve had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain. Years later, the virus may reactivate as shingles.

Shingles is most common in over 50s, and more so in the over 80s category.

If you have a compromised immune system, such as with certain cancer treatments, you may be at greater risk of shingles.

 

Up until July 2020 there were two main Vaccines for shingles in the US –

 

  • Zostavax
  • Shingrix

 

But Shingrix has had more success in protecting people, and especially the over eighties, from getting shingles.

The CDC advises that anyone over the age of 50 get the Shingrix Vaccine for shingles.

Shingles is absolutely horrible, and terribly painful. 

My mom got it in her left eye when she 88, and it was a nightmare.

She was in constant pain for months – about six I believe – and was unable to read, or really do much of anything at all, for the larger part of the  six months.

I had to do almost everything for her, and as all she could do was rest and sleep.

You don’t just get it in the eye though, it can be anywhere on the body and develops a rash which is terribly painful to touch, and when you move.

Shingles can lead to long term nerve pain, numbness and tingling, and long after you have recovered from the actual virus you may still have pain in the nerves in the area where you had the shingles – Neuralgia.

If you wish to learn more about the Shingles vaccine, you can read about it on the Centers for Disease Control and Prevention website here.

What Medical equipment and supplies does Medicare pay for ?

 

Original Medicare gives coverage to equipment for use in the home which it classifies as “durable medical equipment”, or as DME.

Equipment for use in the home is covered by Medicare Part B.

Any supplies or equipment used in a hospital are covered under Medicare Part A – hospital coverage.

 

Equipment will be classed as Durable Medical Equipment by Medicare if it is:-

 

  • Durable (can withstand repeated use)
  • Used for a medical reason
  • Not usually useful to someone who isn’t sick or injured
  • Used in your home
  • Generally has an expected lifetime of at least 3 years

 

Source: Medicare.gov website – here.

The more classic examples of medical equipment which Medicare covers are wheelchairs, crutches and walkers, hospital beds, respirators, patient lifts, and medical oxygen.

But they are covered only when they are medically necessary.

Medicare does not typically cover items which it sees as for convenience or comfort, or which are not primarily medical in nature, such as bath chairs, air purifiers, room heaters, grabbers, cold packs and massage devices.

Original Medicare Part B’s coverage typically extends to 80 % of the Medicare-approved price of the durable medical equipment, and the beneficiary will have to pay their coinsurance of 20% Medicare-approved price, and also, if it applies, their annual deductible.

 

Any disposable medical supplies needed for use with durable medical equipment in the home will typically be covered by Medicare Part B.

Disposable medical supplies which are not used  in conjunction with durable medical equipment, are not typically covered by Medicare Part B.

Supplies which are disposable, not durable, and not used in conjunction with a piece of durable medical equipment that are not covered by Medicare include the following – bandages, face masks, elastic stockings, pressure leotards, support hose, surgical leggings, disposable sheets and bags, fabric supports and incontinence pads.

If blood sugar strips and certain catheters are needed for use in conjunction with durable medical equipment, and, or, to treat long term medical conditions, they may be covered by Medicare Part B.

For individuals receiving Home Health Care, some disposable supplies needed for your care will be covered under the Home Health Care Benefit.

Does Medicare Advantage cover flu shots ?

With a Medicare Advantage Plan, you are covered for all the same services as Medicare Parts A and B, so you will have the same coverage for vaccinations as they provide.

If you use a provider in your plan’s network, you will have nothing to pay.

If you don’t use a provider in their network you could find yourself paying for everything – and don’t rely on the pharmacy to tell you if they work with your provide as they often get it wrong, and you will have to pay.

 

Get free assistance with understanding Medicare

SHIP – State Health Insurance Assistance Programs –

For anyone looking for assistance with Medicare, Medicaid and Medigap, SHIP’s offers free counseling over the phone.

You can check my guide on how to contact your SHIP and get help here“Free Help Understanding Medicare And Medicaid ? Here’s Where You Get It”.

 

Does Medicaid cover flu shots ?

 

It is difficult to say exactly what coverage Medicaid gives to flu shots across the US, as each state is different, and also the standards may vary.

This being said, flu shots are offered to children who receive Medicaid, and in most states to adults on Medicaid as well.

Whether, or not, it is completely free for adults who receive Medicaid is another question, as each state runs its own system.

 

To find your State Medicaid State Agency

 

If you need to talk with, or email someone in your State Medicaid Administration, contact your state Medicaid Agency here.

Follow the steps below once the new window opens.

 

Step 1 –

Click the link to Medicaid.gov, look to the section I outlined in red.

 

Step 2 –

Just select your state and click on “GO” – it will take you to your State Medicaid Agency with all their contact information.

 

I’m Gareth and I’m the owner of Looking After Mom and Dad.com

I have been a caregiver for over 10 yrs and share all my tips here.

Gareth Williams

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