What Medicare covers for RSV vaccine right now

Medicare Part B covers the RSV vaccine for adults 60 and older at no cost to you — no copay, no coinsurance, no deductible. The vaccine is called Arexvy (made by GSK) or Abrysvo (made by Pfizer), and both are covered. You get a single shot, given in the arm, usually at your doctor's office or a pharmacy.

This coverage started in June 2023 when the CDC recommended the vaccine for all adults 60 and up. Medicare added it to the list of covered preventive services, which means your Part B insurance pays the full cost if you go to an in-network provider. If you have a Medigap or Medicare Advantage plan, your coverage may vary slightly, so check with your plan before your appointment.

You do not need to meet a deductible first. The vaccine itself is free. You pay nothing at the time of the shot if your provider is in your plan's network.

Key Takeaways

  • Medicare Part B covers the RSV vaccine for all adults 60 and older at no cost, with no deductible or copay required.
  • Both Arexvy and Abrysvo are covered options, and you receive a single injection.
  • Coverage applies only at in-network providers; using an out-of-network provider may result in higher costs.
  • If you have a Medicare Advantage or Medigap plan, contact your plan directly to confirm your specific coverage before scheduling.

Who qualifies for the vaccine under Medicare

You may have access to if you are 60 or older and enrolled in Medicare Part B. There are no other age cutoffs or health conditions you must have. The CDC recommends it for all older adults in this age group, and Medicare covers it for all of them.

If you are younger than 60, Medicare does not cover the RSV vaccine. Some younger people with certain health conditions (such as chronic lung disease or a weakened immune system) may be candidates for the vaccine, but Medicare does not pay for it in those cases. Your doctor can discuss whether it might be right for you and what your out-of-pocket cost would be.

How to get the vaccine through Medicare

Call your primary care doctor's office or your local pharmacy and ask if they have the RSV vaccine in stock. Tell them you have Medicare and want to know about getting the shot. Many pharmacies — including CVS, Walgreens, and Rite Aid — now carry it and can administer it to Medicare patients.

Bring your Medicare card when you go. The provider will bill Medicare directly. You do not need a referral or prior authorization from Medicare. straightforward schedule an appointment, show up, and get the shot. The whole visit usually takes 15 to 20 minutes.

If you use a Medicare Advantage plan (Part C) instead of Original Medicare, contact your plan first to find out which pharmacies and doctors are in your network. Out-of-network providers may charge you more, even though the vaccine itself is covered.

What happens if you have a Medicare Advantage or Medigap plan

Medicare Advantage plans (Part C) must cover the RSV vaccine at no cost because it is a Medicare-covered preventive service. However, you must use an in-network provider. If you go out of network, you may owe a copay or coinsurance. Call your plan's customer service number (on the back of your card) and ask which doctors and pharmacies near you offer the vaccine.

Medigap plans do not directly cover the vaccine — Medicare Part B does. Your Medigap plan covers some of the costs that Medicare does not pay (like copays or coinsurance), but since the RSV vaccine has no copay under Medicare, your Medigap plan has nothing to pay. You still pay nothing out of pocket.

If you are not sure whether you have Original Medicare, Medicare Advantage, or Medigap, look at your Medicare card or call 1-800-MEDICARE to confirm.

Timing and whether you need a booster

You can get the RSV vaccine at any time during the year. There is no specific season or important date. Many people choose to get it in the fall before respiratory illness season picks up, but that is not required.

As of 2024, the vaccine is a single dose. You do not need a booster shot. If new guidance changes this in the future, Medicare will update its coverage, and your doctor will let you know.

If you have already received an RSV vaccine outside of Medicare (for example, if you paid out of pocket before turning 60), talk to your doctor about whether you need another dose now that Medicare covers it. In most cases, one dose is enough, but your doctor can advise based on your health history.

What to ask your doctor before you get the shot

Ask whether the RSV vaccine is right for you given your current health. Most people 60 and older benefit from it, but if you have a severe allergy to any ingredient in the vaccine or have had a serious reaction to a previous dose, your doctor may recommend against it.

Ask which vaccine your provider has in stock — Arexvy or Abrysvo — and whether there is any difference for you. Both are effective and covered by Medicare. Ask when you can get it and whether you need to do anything before your appointment.

If you take blood thinners or have a bleeding disorder, mention that before your appointment so the provider can give the shot in the right location and watch for any bleeding.

When to contact Medicare or your doctor

Contact your doctor if you have a severe allergic reaction after the shot — such as difficulty breathing, swelling of the face or throat, or chest pain. Call 911 if symptoms are severe.

Mild side effects like arm soreness, low fever, or fatigue are normal and usually go away within a few days. You do not need to call your doctor for these.

If you have questions about whether Medicare covers the vaccine or whether you are enrolled in the right plan, call 1-800-MEDICARE. They can confirm your coverage and help you find a provider near you.

Frequently Asked Questions

Do I have to get the RSV vaccine if I have Medicare?

No. The vaccine is covered by Medicare, but getting it is your choice. Your doctor can discuss whether it is right for you based on your health, but Medicare does not require you to get it.

What if I got the RSV vaccine before I turned 60 and had to pay for it myself?

You likely do not need another dose. One dose is protective. Talk to your doctor about your vaccination history. If you have questions about reimbursement for a vaccine you paid for before Medicare coverage began, contact 1-800-MEDICARE.

Will the RSV vaccine protect me from getting RSV?

The vaccine reduces your risk of getting RSV and significantly lowers the chance of severe illness if you do get infected. It does not may provide you will not get RSV, but it provides strong protection, especially against serious outcomes.

Can I get the RSV vaccine at the same time as my flu or COVID-19 vaccine?

Yes. You can receive the RSV vaccine and other vaccines (flu, COVID-19, pneumococcal) at the same appointment. Your doctor or pharmacist will give them in different arms. There is no waiting period between them.

What if my pharmacy says they do not have the vaccine in stock?

Ask when they expect to receive it, or call other pharmacies in your area. You can also ask your doctor's office if they have it available. Availability varies by location, but most major pharmacies and doctor's offices now carry one or both RSV vaccines.