Medicare covers the RSV vaccine for adults 60 and older, with no out-of-pocket cost if you use an in-network provider

Medicare Part B covers the respiratory syncytial virus (RSV) vaccine for people aged 60 and older. If your doctor gives you the shot at a participating Medicare provider, you pay nothing — no copay, no coinsurance, no deductible. The vaccine itself and the administration are both covered.

This coverage began in June 2023, when the Centers for Medicare & Medicaid Services (CMS) approved the RSV vaccine for older adults. Two vaccines are currently available: Arexvy (made by GSK) and Abrysvo (made by Pfizer). Both are covered under the same terms.

If you receive the vaccine at an out-of-network provider or a facility that does not accept Medicare assignment, you may owe money out of pocket. Always confirm that your doctor or clinic participates in Medicare before your appointment.

Key Takeaways

  • Medicare Part B covers the RSV vaccine at no cost for adults 60 and older when administered by an in-network provider.
  • Both Arexvy and Abrysvo vaccines are covered; your doctor will recommend which one is right for you.
  • You pay nothing if the provider accepts Medicare assignment, but you may owe money if you go to an out-of-network facility.
  • You do not need a referral from your primary care doctor to receive the vaccine at a participating provider.

How to learn about your doctor offers the RSV vaccine

Start by calling your primary care doctor's office or the clinic where you usually receive vaccines. Ask whether they have the RSV vaccine in stock and whether they accept Medicare. If they do not yet offer it, ask for a referral to a nearby provider who does.

You can also search the Medicare provider directory at Medicare.gov. Use the "Care Provider" search tool and filter for your area. Many pharmacies that participate in Medicare — including CVS, Walgreens, and Rite Aid — now offer the RSV vaccine. Call ahead to confirm they have it available and to schedule an appointment, as supplies vary by location.

If you belong to a Medicare Advantage plan (Part C), contact your plan directly to find out which providers in your network offer the vaccine. Coverage rules are the same, but your plan may have a list of preferred locations.

What happens during and after the vaccine visit

The RSV vaccine is a single injection, usually given in the upper arm. The appointment takes about 15 to 20 minutes. You do not need to fast or prepare in any special way beforehand.

After the shot, you may experience mild side effects such as arm soreness, fatigue, muscle aches, or low-grade fever. These typically go away within a few days. Serious side effects are rare. If you have concerns about side effects or if symptoms persist, contact your doctor.

Your provider will record the vaccine in your medical record and in the national immunization registry. You do not need to carry a separate vaccine card, though your provider can give you one if you ask.

Who should and should not get the RSV vaccine

Medicare covers the vaccine for all adults 60 and older. Your doctor may recommend it especially if you have chronic lung disease, heart disease, diabetes, or a weakened immune system — conditions that put you at higher risk for severe RSV illness.

If you have had a severe allergic reaction to any ingredient in the vaccine, tell your doctor before the appointment. If you are currently ill with a fever or other acute illness, your provider may ask you to reschedule. Pregnancy is not a reason to avoid the vaccine, but it is uncommon for pregnant people to receive it; discuss your individual situation with your doctor.

If you are unsure whether the vaccine is right for you, your doctor can review your health history and help you decide. You do not need to get the vaccine if you do not want to — it is your choice.

RSV vaccine and other vaccines you might need

You can receive the RSV vaccine at the same visit as other vaccines, such as the flu shot, pneumococcal vaccine, or shingles vaccine. There is no waiting period between them. Your provider will keep track of which vaccines you have received and when.

If you are due for multiple vaccines, scheduling them together can save you a trip. Let your provider know which vaccines you need so they can prepare.

What to do if your provider says they cannot bill Medicare

Some providers, especially smaller clinics or independent practices, may not yet be set up to bill Medicare for the RSV vaccine. If this happens, ask whether you can pay out of pocket and then submit a claim to Medicare yourself. Keep your receipt and any paperwork the provider gives you.

You can also contact Medicare directly at 1-800-MEDICARE to ask which providers in your area are billing for the RSV vaccine. The representative can give you a list of locations that accept Medicare assignment.

Do not let a provider tell you that Medicare does not cover the vaccine — it does. If you encounter resistance, it is often a sign that the provider is not yet familiar with the coverage. Asking to speak with the office manager or calling back another day may help.

Frequently Asked Questions

Do I need a doctor's order to get the RSV vaccine?

No. You can walk into a participating pharmacy or clinic and request the vaccine without a referral or prior authorization from your primary care doctor. However, it is a good idea to mention it to your doctor at your next visit so they can note it in your medical record.

Can I get the RSV vaccine if I have Medicare Advantage instead of Original Medicare?

Yes. Medicare Advantage plans must cover the RSV vaccine under the same terms as Original Medicare — at no cost to you. Contact your plan to find in-network providers near you.

What if I already had RSV disease — do I still need the vaccine?

Yes. Having had RSV in the past does not provide lasting immunity. The vaccine is still recommended for adults 60 and older, regardless of whether you have had the virus before.

Is there a limit to how many times I can get the RSV vaccine?

Currently, the vaccine is given as a single dose. Experts are still studying whether a second dose will be needed in future years. Your doctor will let you know if recommendations change.

What if I am 59 years old — can I get the vaccine?

Medicare coverage is limited to adults 60 and older. If you are younger and interested in the vaccine, ask your doctor whether it might be right for you; some younger people with certain health conditions may benefit. Your doctor can discuss options with you.