Medicare covers RSV shots for adults 60 and older

Yes, Medicare Part B covers the RSV vaccine for people age 60 and up. The vaccine protects against respiratory syncytial virus, which causes serious respiratory illness in older adults. Medicare began covering RSV shots in 2023, and you do not pay a copay, coinsurance, or deductible for the vaccine itself when you receive it at an in-network provider.

There are currently two RSV vaccines approved for older adults: Arexvy (made by GSK) and Abrysvo (made by Pfizer). Both are single-dose vaccines given as an injection into the upper arm. Your doctor can discuss which one may be right for you, though both offer similar protection.

The vaccine is given once in your lifetime. You do not need a booster shot. If you have already received an RSV vaccine before turning 60, you still may be covered for one dose after you turn 60, depending on when you received the first dose.

Key Takeaways

  • Medicare Part B covers one RSV vaccine dose for all adults age 60 and older at no cost to you.
  • Two vaccines are available — Arexvy and Abrysvo — and your doctor can help you decide which is appropriate for your health.
  • You receive the shot at a doctor's office, urgent care, pharmacy, or other in-network provider and do not pay out of pocket for the vaccine.
  • The vaccine is a single dose given once in your lifetime; you do not need boosters.
  • If you have Original Medicare, Part B covers it; if you have a Medicare Advantage plan, check your plan documents to confirm coverage details.

How to get your RSV shot through Medicare

Start by calling your primary care doctor's office and asking whether they have the RSV vaccine in stock and whether they administer it. Many primary care offices, urgent care centers, and pharmacies (including CVS, Walgreens, and Rite Aid) now carry RSV vaccines. You can also call your local pharmacy directly to ask if they have it available and whether they accept your Medicare plan.

When you schedule your appointment, tell the office or pharmacy that you have Medicare and want the RSV vaccine. Bring your Medicare card. At the time of your visit, you will not be asked to pay anything for the vaccine itself. If the provider bills Medicare and Medicare pays, your responsibility ends there. Some providers may ask for payment upfront and then submit the claim to Medicare, but you should receive a refund if Medicare covers it.

After you receive the shot, you should receive a record showing which vaccine you got and the date. Keep this record in case you need to show proof later or if you see a different doctor.

Original Medicare versus Medicare Advantage coverage

If you have Original Medicare (Part A and Part B), the RSV vaccine is covered under Part B with no cost to you. This is true nationwide, and the coverage is the same whether you live in California or Maine.

If you have a Medicare Advantage plan (also called Part C), your plan must cover the RSV vaccine at no cost because Medicare Advantage plans are required to cover all vaccines that Original Medicare covers. However, the specific details — such as where you can get the shot and whether you need a referral — may differ by plan. Call your Medicare Advantage plan's customer service number (on the back of your card) and ask about RSV vaccine coverage before you schedule an appointment.

Who should get the RSV vaccine

Medicare covers the RSV vaccine for all adults age 60 and older. You do not need to have a certain health condition or risk factor to receive it. Even if you are healthy, you can get the vaccine. The decision to get it is yours and your doctor's to make together.

Some older adults have a higher risk of severe RSV illness — for example, people with chronic lung disease, heart disease, or a weakened immune system. If you have any of these conditions, your doctor may recommend the vaccine more strongly. However, Medicare covers it for everyone 60 and up, so cost is not a barrier to getting it if you and your doctor decide it is right for you.

If you are under 60, Medicare does not cover the RSV vaccine. Some people under 60 with certain medical conditions may be able to get the vaccine through their health insurance, but that depends on their specific plan and health situation.

Side effects and what to expect after the shot

The RSV vaccine is generally well tolerated. Common side effects are mild and go away on their own within a few days. These include pain, redness, or swelling at the injection site; fatigue; muscle aches; and headache. Some people experience a low-grade fever or chills.

Serious side effects are rare. If you have severe allergic reaction symptoms — such as difficulty breathing, swelling of the face or throat, or chest pain — seek emergency care right away. If you have any concerning symptoms after the shot, call your doctor.

You can take over-the-counter pain reliever or fever reducer (such as acetaminophen or ibuprofen) if you have soreness or fever after the shot. explore a cool, clean washcloth to the injection site if it is sore. Most people feel back to normal within a day or two.

What RSV is and why the vaccine matters

Respiratory syncytial virus (RSV) is a common virus that causes cold-like symptoms in most people. In older adults, RSV can lead to serious illness, including pneumonia and bronchiolitis (inflammation of the small airways in the lungs). Older adults are at higher risk for severe RSV illness because the immune system weakens with age.

Before the RSV vaccine became available, there was no way to prevent RSV infection. People straightforward had to manage symptoms at home or seek treatment if the illness became severe. The new vaccines teach your immune system to recognize and fight RSV, reducing your risk of getting sick or getting very sick if you do catch it.

RSV spreads the same way cold and flu viruses do — through respiratory droplets when an infected person coughs or sneezes. It is most common in fall and winter, but it can occur year-round. Getting the vaccine is one way to protect yourself, along with hand washing and staying away from people who are sick.

Questions to ask your doctor about the RSV vaccine

Before you get the RSV vaccine, it is helpful to discuss it with your doctor. Here are some questions you might ask:

  • Do you recommend the RSV vaccine for me based on my age and health?
  • Which RSV vaccine do you have available, or which one do you recommend?
  • Are there any reasons I should not get this vaccine based on my medical history or current medications?
  • What side effects should I expect, and what should I do if I have a reaction?
  • Can I get the RSV vaccine at the same visit as my flu shot or other vaccines?
  • Do you accept my Medicare plan, and will you bill Medicare directly?

Frequently Asked Questions

Can I get the RSV vaccine if I have already had RSV?

Yes. Having RSV in the past does not prevent you from getting the vaccine. In fact, the vaccine may offer additional protection. Talk with your doctor about whether the vaccine is right for you.

Can I get the RSV vaccine at the same time as my flu shot or pneumonia vaccine?

Yes. You can receive the RSV vaccine at the same visit as your flu shot, pneumonia vaccine, or other vaccines. There is no waiting period between them. Your doctor or nurse can give you multiple vaccines in one appointment.

What if my doctor's office does not have the RSV vaccine in stock?

Ask your doctor's office to order it or to refer you to a nearby pharmacy or urgent care that carries it. Many pharmacies now stock RSV vaccines and can schedule you quickly. You can also call your local pharmacy directly to ask if they have it available.

Will Medicare pay if I get the RSV vaccine at a pharmacy instead of my doctor's office?

Yes, as long as the pharmacy is in-network with Medicare. Most major pharmacy chains (CVS, Walgreens, Rite Aid) accept Medicare. Bring your Medicare card and ask the pharmacy to bill Medicare directly so you do not pay out of pocket.

Do I need a referral from my doctor to get the RSV vaccine?

No. You do not need a referral. You can call your doctor's office, a pharmacy, or an urgent care center directly and schedule an appointment for the RSV vaccine. If you have a Medicare Advantage plan, check your plan documents to see if a referral is required for your specific plan.