Medicare Coverage of Flu Shots
What It Is
Flu vaccination for seasonal flu
Medicare Part B or a Medicare Part C plan covers one flu shot per flu season, usually in the fall or winter. A patient who's covered for a flu shot administered in the winter after January 1 may be covered for a flu shot during the next flu season the following fall, even if that second shot is administered within the same calendar year as the first.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for flu shots, contact the plan directly.
What Medicare Pays
For flu shots administered at a clinic or temporary public health site (such as a pharmacy, supermarket, or library), Medicare Part B pays the full cost of the shot. If the flu shot is administered by a doctor or other provider who doesn't accept assignment of the Medicare-approved amount, Medicare Part B pays 80 percent of that Medicare-approved amount.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.