Medicare and Flu Shots
This article was updated on: 09/12/2018
According to the National Institutes of Health (NIH), the influenza virus infects up to 20% of the population each year, sending more than 200,000 people to the hospital. Roughly 36,000 will die from the flu each flu season, with the most severe outcomes affecting individuals ages 65 and over.
The Centers for Disease Control and Prevention (CDC) recommends that everyone age 6 months and older gets an annual flu shot.
If you are enrolled in Original Medicare (Part A and Part B), your Part B benefits typically cover preventive care such as flu shots at no cost to you if your health care provider accepts assignment. Everyone with Medicare Part B coverage is eligible for one flu shot during each flu season.
How effective is the flu shot?
The CDC studies the effectiveness of the flu shot each year and its research shows that flu shots reduce the risk of illness by between 50% and 60%. A recent study showed that adults age 50 and over reduced their chances of being hospitalized for the flu by 57%.
The main factor affecting the vaccine’s effectiveness is whether each year’s vaccine “matches” the flu viruses found in the community.
Who is at high risk for complications from the flu?
According to the CDC, most people who get the flu will only be mildly ill and will recover without medical care in two weeks or less. However, certain people are at a higher risk for serious complications from the flu virus. If any of these apply to you, you may be at higher risk:
- Individuals under age 2 or age 65 and over
- Residents of nursing homes or long term care facilities
- Pregnant women and women who have recently given birth
- American Indians and Native Alaskans
- People with certain health conditions including asthma, chronic lung or heart disease, neurological disorders, blood disorders, diabetes, diseases of the liver or kidneys, cancer, HIV/AIDS, weakened immune systems, and extreme obesity with a body mass index of 40 or greater
Does Medicare cover high-dose flu shots?
High-dose flu shots are made available each year to individuals age 65 and over. According to the Centers for Disease Control and Prevention, data suggests that older people get a better immune response from the high-dose flu shots. This is because the immune systems weakens as individuals age and a higher dose of vaccine provides better protection against the flu.
Since older individuals are at higher risk for severe complications from the flu, some doctors recommend the high-dose flu shot for their patients age 65 and over. The CDC’s Advisory Committee on Immunization Practices does not endorse a preference at this time for the high-dose flu shot over the standard one; its recommendation is only that everyone age 6 months and over get the shot unless a health condition prevents it.
If your health care provider recommends the high-dose flu shot, Medicare Part B may cover the injection at no cost to you once each year during flu season if your doctor accepts assignment.
Note that if you are enrolled in a Medicare Advantage plan, your flu shot is also covered. Medicare Advantage (Medicare Part C) must provide, at a minimum, all the same benefits as Original Medicare , except for hospice care which is still covered under Part A. You must continue to pay your Part B premiums if you enroll in Medicare Advantage, as well as any additional premiums required by your plan.
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