Flu season is around the corner, and we haven’t yet made it out of Covid-19, so it’s really important to make sure that our elderly loved ones get their flu vaccines as soon as they become available.
Medicare Part B will cover a flu shot at Walgreens. There is no deductible for flu shots, and as Walgreens are Medicare-enrolled and accept assignment, so there is no coinsurance to pay.
Contents Overview & quicklinks
Walgreens on-site flu shots
On-site Walgreens offers –
- quadrivalent vaccines
- high dose vaccines, which are designed specifically for seniors 65 years and over
Don’t forget to take your insurance information, a photo ID and to complete the assessment/consent form in advance which you can find and print out from the Walgreens website here.
You can read about the process on the Walgreens website here.
How much is a flu shot at Walgreens if you don’t have insurance ?
A flu vaccine without insurance cover at Walgreens costs –
- quadrivalent flu vaccine – $31.99
- high dose flu vaccine – $54.00
What is the flu ?
Caused by Influenza Viruses, flu is a really contagious respiratory illness.
An infected person can transmit the flu as they talk, cough or sneeze, to people up to six feet away.
It may also be possible to catch flu by touching a surface which has the flu virus on it, and then touching the nose or mouth.
People are at their most contagious in the first 3 -4 days of the illness.
An adult may be able to infect other people, from the day before they realize they have the flu, and then for a further 7 days.
Influenza viruses A and B cause seasonal flu outbreaks between November to April.
Certain groups are at greater risk of serious health complications from the flu than others.
The groups at greater risk are –
- the elderly
- young children under the age of 5
- people with certain underlying health conditions
If you want to find out more, you can look on the Centers for Disease and Prevention website here.
Why should the elderly get flu shots ?
The following text makes a compelling argument for the elderly to get immunized against the flu.
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 text is from the NCOA Center for Benefits access – “Vaccines: What Medicare pays for” which you can read here.
The immune system is less able to defend your body against infections and viruses the older you get.
Unfortunately, this also means the older a person is, the more likely they are to catch the flu when they are to come into contact with the virus.
On top of this, the older you are, the more likely you are to develop serious complications from the flu, such as pneumonia.
The flu is an even greater risk for over 65’s who have underlying health conditions causing serious complications, such as pneumonia.
The underlying health conditions which put a person at increased risk include –
- heart disease
- asthma or COPD
- liver or kidney disease
- a compromised immune system
Cancer treatment, HIV/AIDS, steroids and other forms of anti-inflammatory treatments can compromise the immune system, making it vulnerable to the flu virus.
As the flu virus mutates from year to year, previous vaccines may no longer be effective the following season, making it important to renew the vaccine with each season.
You are protecting those around you when you get the flu shot, so it is important for caregivers, children and grandchildren who have contact with elderly adults, to get the vaccine each year.
What are the different types of flu vaccine ?
The standard Influenza Vaccines available to adults are –
- Quadrivalent Influenza Vaccine
- High-Dose Flu Vaccine
- Intradermal Influenza Vaccine
- Adjuvanted Vaccine
- Cell-based Flu Vaccine
- Recombinant Flu Vaccines
- Nasal Spray Vaccine
Those vaccines recommended for the over 65’s are –
- High-Dose Flu Vaccine
- Adjuvanted Vaccine
This information is from the Centers for Disease and Prevention website here if you wish to learn more.
Does Medicare cover the quadrivalent flu vaccine ?
The quadrivalent flu vaccine is one of the vaccines covered by Medicare Part B.
Here is a list of influenza quadrivalent vaccines from the Centers for Medicare and Medicaid Services which are covered in the 2020-2021 flu season.
- Fluad Quadrivalent
- Fluzone High-Dose Quadrivalent
- Flucevax Quadrivalent
- FluMist Quadrivalent
- Flubok Quadrivalent
- Fluzone Quadrivalent
- Afluria Quadrivalent
- Fluarix Quadrivalent
- Flulaval Quadrivalent
You can find the list here on the Centers for Medicare and Medicaid Services.
Does Medicare pay for flu shots at a pharmacy ?
Medicare Part B will cover one flu shot per season, at pharmacies, if they are Medicare-enrolled and accept assignment.
There are systems with supervising physicians at pharmacies, and standing orders, which may vary by state, which have been designed to increase immunization against the flu and pneumonia viruses.
In some states, the pharmacist themselves can give shots, but this varies by state.
As long as the pharmacy is a Medicare-enrolled pharmacy which accepts assignment.
With the flu and the pneumonia vaccines you do not have to pay a deductible, and if the pharmacy accepts assignment you do not have to pay any coinsurance.
The pharmacy if it is Medicare-enrolled should bill Medicare directly.
Don’t forget to ask the pharmacist to have the information on the vaccination forwarded to your primary care doctor to have your records updated.
Does Medicare pay for flu shots at Walmart ?
Medicare Part B covers flu shots at Walmart, as long as you are enrolled in Medicare Part B and you haven’t already had a shot in the flu season in question – flu season runs from November to April.
Walmart is Medicare-enrolled and bill Medicare the flu shot – there will be no deductible or co-pay.
Does Medicare pay for flu shots at CVS ?
Medicare Part B does cover flu shots at CVS, as long as you are Medicare-enrolled in Medicare Part B, and you haven’t already had a shot in the same flu season.
Just like Walgreens and Walmart, CVS is Medicare-enrolled and accepts assignment.
CVS will bill Medicare the flu shot, and again there will be no deductible or coinsurance for you to pay.
Does Medicare cover flu shots at Costco ?
If you have Medicare Part B, you will get your flu shot at Costco for free.
Costco’s pharmacies will bill Medicare directly, and you will have nothing to pay.
Does Medicare cover flu shots at Rite Aid ?
If you are enrolled in Medicare Part B, you will not have to pay for a flu vaccine at Rite Aid.
Rite Aid should bill Medicare directly for the flu shot, and you should have nothing to pay, this also means no deductible or coinsurance to pay to Medicare either.
Does Medicare cover pneumonia shots ?
The pneumococcal (pneumonia) vaccine is covered by Medicare Part B.
If you visit a provider who is Medicare-enrolled, and who accepts assignment there is no co-pay, and as with the flu shot there is no deductible.
There are two types of pneumococcal vaccine given in the US.
Medicare offers a first vaccine, and if your physician considers it necessary, you may receive the second pneumonia shot at least one year later.
The two shots protect against different strains of the pneumococcal bacteria.
Pneumococcal bacteria infections are responsible for a number of different illnesses –
- ear infections
- sinus infections
The Centers for Disease Control and Prevention recommends that all over 65’s get the pneumococcal vaccine.
If you have certain underlying health conditions, you may need to get the pneumococcal vaccine once every 5 years (there is a booster), but typically you only get it once.
It is possible to get the pneumococcal vaccine and the flu vaccine at the same time.
You can find more on the Centers for Disease Control and Prevention website here.
Does Medicare cover pneumonia shots at Walgreens ?
Medicare Part B does cover the pneumococcal vaccine at Walgreens.
As long as you are enrolled in Medicare Part B, you can get the Pneumococcal vaccine without deductible or co-pay.
Walgreens gives the two types of pneumococcal vaccine –
PPSV23 – pneumococcal polysaccharide vaccine protects against 23 types of pneumonia bacteria
PCV13 – pneumococcal conjugate vaccine protects against 13 types of pneumonia bacteria, including those most likely to cause serious disease.
You can read more about pneumonia shots at Walgreens here.
You just need to take along your insurance information, and a photo ID.
You can make an appointment at a Walgreens near you on this page of their site here.
What vaccines are covered by Medicare ?
Medicare Part B covers –
The Influenza vaccine –
- Medicare will cover one flu shot per flu season that is from November to April
- additional flu shots may be covered if it is considered medically necessary
- there is no deductible for the flu shots
- there is no co-insurance to pay so long as the practitioner and provider accept assignment
The Pneumococcal (pneumonia) vaccine
- Medicare pays for one shot
- it is recommended for all adults over the age of 65
- if it is medically necessary for people with underlying health conditions, there is a 5 yearly booster
- there is no deductible for pneumonia shots
- there is no co-insurance to pay if you use a practitioner and provider who accept assignment
The Hepatitis B Vaccine –
- Medicare pays for a series of three shots for high or medium risk individuals
- you pay nothing as long as the health care provider for the Hepatitis B Vaccine accepts assignment – this means that they are Medicare-enrolled and that they accept the medicare approved price
The Tetanus Vaccine –
in the case of an injury or illness, Medicare Part B will cover the Tetanus Vaccine if it is “medically necessary” and prescribed by a Medicare-enrolled physician.
Medicare Part C (Medicare Advantage) covers –
- Medicare Part C will by law have to cover the same services as Original Medicare Parts A and B, so they all cover the Influenza Vaccine, the Pneumococcal Vaccine, the Hepatitis B Vaccine and in the case of an injury or illness the Tetanus Vaccine
- as long as you are using your plan in-network provider, you will not have to pay a deductible or co-insurance
- the plans will have their own networks of providers, practitioners and suppliers, so you need to find out who they are from the plan providers, otherwise you may fall foul of reimbursement
- some Medicare Advantage plans may cover the Shingles Vaccine and both Tetanus Vaccines
Medicare Part D covers –
The Shingles Vaccine –
- Part D plans pay for Shingrix which is recommended for adults over the age of 60
- each Medicare Part D plan is different, so the amount to which they cover the Shingles Vaccine will vary with each provider
- the amounts of the co-pay will depend on your Medicare Part D plan
- each Medicare Part D plan will have its own rules for administration and for payment
The Shingles vaccine called Zostavax been removed from US since the 1st of July 2020.
The Tdap Vaccine –
- Tdap is for tetanus, diphtheria and pertussis (whooping cough)
- Part D plans pay for Tdap which is a booster for adolescents and adults (as a child you get the DTaP Vaccine)
- how much Tdap costs will depend on the Medicare Part D plan that you have signed up to
- each Medicare Part D plan will have its own rules for administration and for payment
Medicare Part D plans cover the commercially available vaccines for most diseases, which are not covered by Medicare Part B.
Vaccines which are needed for vacations abroad, if they are not covered by Medicare Part B, will be covered by Medicare Part D plans, and again the deductibles and co-pays will depend on the plan providers.
To find out what these vaccines cost, you will have to contact your Medicare Part D plan provider.
What 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 –
- end stage renal disease
- 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 go 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 shingle sin the US –
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 supplies and equipment does Medicare cover ?
For equipment which is to be used in the home, Original Medicare give coverage to items which it considers to be “durable medical equipment”, or as DME.
It is Medicare Part B which covers equipment for “use in the home”.
Supplies or equipment, used in a hospital or other skilled nursing facility, are covered under Medicare Part A – hospital coverage, and not under Medicare Part B.
Equipment to be classed as Durable Medical Equipment by Medicare has to be:-
- 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
Typical examples of DME which Medicare covers are wheelchairs, medical oxygen and walkers and hospital beds.
But note that they are covered only when it has been declared that they are medically necessary.
Medicare will typically give coverage to items that it sees as convenience or comfort items, or which are not primarily medical in nature.
This is items such as grab bars, air purifiers, room heaters, grabbers, over-bed tables and massage devices.
On the occasion that Medicare does give coverage for equipment, Part B’s coverage typically extends to 80 % of the Medicare-approved price of the durable medical equipment, and you will be responsible for your coinsurance of 20% Medicare-approved price, and if it applies, your annual policy deductible.
Disposable Medical Supplies
Disposable medical supplies used in conjunction with DME in the home will typically be covered by Medicare Part B.
If disposable medical supplies are not being used in conjunction with DME, they are not typically covered by Medicare Part B.
Disposable supplies which are not durable, and not used in tandem with a piece of durable medical equipment (actually needed for the DME’s functioning), which don’t typically get coverage from Medicare Part B include the following items – bandages
- face masks
- elastic stockings
- pressure leotards
- support hose
- surgical leggings
- disposable sheets
- fabric supports
- incontinence pads
Certain catheters and blood sugar strips may be covered by Medicare Part B if they are needed for use in conjunction with durable medical equipment, and, or, to treat long term medical conditions
For those individuals receiving Home Health Care, certain disposable supplies needed for their care can get coverage under the Home Health Care Benefit from Medicare.
Does Medicare Advantage cover flu shots ?
Medicare Advantage Plans cover you for all the same services as Medicare Parts A and B, so you will have the same coverage for vaccinations as they provide.
You will though have to find out from your Advantage plan provider which pharmacies they wish to use, and if you stay in their network you should, as with Medicare Part B, not have ot pay anything.
Don’t rely on the pharmacy to tell you if your Advantage plan insurance covers you with them, as they often get it wrong, and you will have to pay.
Free help with understanding Medicare
SHIP – State Health Insurance Assistance Programs
Everyone can get free counseling services for Medicare, Medicaid and Medigap, over the phone from their state program.
I wrote an article about contacting your SHIP, which you can find that 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, but if you qualified for Medicaid the following groups are covered –
- children six months to four yrs old
- women who will be pregnant during the flu season
- children and adults who have compromised immune systems, including from HIV or medications
- children and adults who have lung, heart, liver, kidney disease, are undergoing cancer treatment or have diabetes
- children between the ages of 6 months and 18 years who are undergoing long term aspirin therapy
- residents of state nursing homes and long term care facilities
- adults over the age of 50
Medicaid will cover the cost of the flu shots.
To find your State Medicaid State Agency
If you need to talk, or to email someone, in your State Medicaid Administration, you can contact your state Medicaid Agency here.
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, the author and owner of Looking After Mom and Dad.com
I have been a caregiver for over 10 yrs and share all my tips here.