Medicare covers RSV vaccination for adults 60 and older

Medicare Part B covers the RSVPreF3 vaccine (brand name Arexvy) and the RSVPreF120 vaccine (brand name Abrysvo) for people age 60 and up, with no out-of-pocket cost to you. Both vaccines protect against respiratory syncytial virus, a respiratory infection that can be serious in older adults. Medicare began covering these vaccines in 2023, and coverage is automatic — you do not need to request special permission from Medicare before getting the shot.

The vaccine is given as a single injection, usually in the upper arm, at your doctor's office, pharmacy, or other healthcare provider that administers vaccines. Your provider will bill Medicare directly, and you pay nothing at the point of service.

Key Takeaways

  • Medicare Part B covers RSV vaccination for all beneficiaries age 60 and older at no cost to you.
  • You can receive the vaccine at your doctor's office, a pharmacy, or any provider that administers vaccines and accepts Medicare.
  • No prior authorization or special request is required — Medicare covers the vaccine automatically when your provider bills for it.
  • If you are under 60, RSV vaccination may be covered under Part D (prescription drug coverage) or not covered at all, depending on your specific plan.
  • Talk to your doctor about whether RSV vaccination is right for you, especially if you have chronic heart or lung disease.

How to get the RSV vaccine through Medicare

Start by calling your doctor's office or a local pharmacy and asking whether they have RSV vaccine in stock and whether they administer it. Many primary care offices, urgent care clinics, and major pharmacy chains (CVS, Walgreens, Rite Aid) now carry the vaccine. When you schedule your appointment, tell the provider that you have Medicare and are age 60 or older.

Bring your Medicare card with you. The provider will verify your coverage at the time of your visit and bill Medicare Part B directly. You will not receive a bill afterward. If for any reason your provider asks you to pay, contact Medicare at 1-800-MEDICARE to report the issue and confirm your coverage.

What happens if you are under 60

If you are under 60 and enrolled in Medicare (for example, because you receive Social Security Disability Insurance), RSV vaccination coverage depends on your specific plan. Some Medicare Advantage plans and Part D prescription drug plans may cover the vaccine, but others do not. Contact your plan directly to ask whether RSV vaccination is covered under your benefits.

If your plan does not cover it, you can still receive the vaccine by paying out of pocket. The cost varies by provider and location but typically ranges from $100 to $300 per dose. Ask your provider for the price before you schedule.

Who should get the RSV vaccine

Medicare covers the vaccine for all adults 60 and older, but that does not mean everyone in that age group needs it. The decision to get vaccinated is between you and your doctor. RSV vaccination may be especially important if you have chronic heart disease, chronic lung disease (including asthma or COPD), a weakened immune system, or if you live in a setting with other older adults, such as a nursing home or assisted living facility.

If you have had a severe allergic reaction to any ingredient in the RSV vaccine in the past, you should not receive it. Tell your doctor about any allergies or previous vaccine reactions before your appointment.

Common questions about RSV vaccine and Medicare

Some people wonder whether they need a doctor's order to receive the RSV vaccine at a pharmacy. In most states, pharmacists can administer the RSV vaccine without a standing order from your doctor, though a few states still require one. Call ahead to confirm your pharmacy's policy. If your pharmacy requires a doctor's order and you do not have one, your doctor's office can send it electronically or by fax.

Another question is whether you can receive the RSV vaccine at the same visit as other vaccines, such as the flu shot or pneumococcal vaccine. Yes, you can receive multiple vaccines at the same appointment, though some providers may space them out by a few days. Ask your provider what they recommend.

What to expect after the vaccine

Most people experience mild side effects or none at all. Common reactions include soreness, redness, or swelling at the injection site, fatigue, muscle aches, or a low-grade fever. These effects usually fade within a few days. Serious side effects are rare.

If you experience severe allergic reaction symptoms — difficulty breathing, swelling of the face or throat, or chest pain — seek emergency care when ready. For any other concerns after vaccination, contact your doctor.

If your provider says Medicare will not cover it

If a provider tells you that Medicare will not cover the RSV vaccine, ask them to check your coverage again or contact Medicare directly. Medicare Part B covers RSV vaccination for all beneficiaries 60 and older with no restrictions. If a provider refuses to bill Medicare or insists you must pay, you can report this to Medicare at 1-800-MEDICARE or file a complaint with your state's health department.

Keep any receipts or documentation if you pay out of pocket, in case you need to dispute a charge or request reimbursement later.

Frequently Asked Questions

Do I need to ask my doctor for permission before getting the RSV vaccine?

No. Medicare covers the vaccine automatically for adults 60 and older. You can walk into a pharmacy or call your doctor's office to schedule an appointment without needing prior approval. Your provider will verify your Medicare coverage when you arrive.

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

Yes. Having had RSV in the past does not prevent you from receiving the vaccine. The vaccine can still help protect you from future RSV infection. Talk to your doctor if you have questions about your specific situation.

Will the RSV vaccine affect my other medications?

The RSV vaccine does not interact with most medications. If you take blood thinners or immunosuppressant drugs, mention this to your provider before vaccination so they can advise you on timing. For most people, there are no medication interactions to worry about.

What if I missed getting the vaccine last year — can I still get it now?

Yes. There is no important date for RSV vaccination. You can receive it at any time. If you are 60 or older and have Medicare, you are covered whenever you decide to get the vaccine.

Does my Medicare Advantage plan cover RSV vaccination the same way Original Medicare does?

Yes. All Medicare Advantage plans must cover the same vaccines that Original Medicare covers, including RSV vaccination for adults 60 and older, at no cost to you. Check your plan documents or call your plan's customer service to confirm, but coverage should be identical.