What Medicare covers for RSV shots

Medicare Part B covers the RSV vaccine (Arexvy, made by GSK, and Abrysvo, made by Pfizer) at no cost to you if your doctor prescribes it. You pay nothing out of pocket — no copay, no coinsurance, no deductible. The vaccine is a single shot given in the upper arm, usually during a routine office visit.

This coverage applies to adults 60 and older. Your doctor decides whether the shot makes sense for you based on your health history and risk factors. Medicare does not require prior approval before you get the shot, though your doctor's office may contact Medicare to confirm coverage before your appointment.

The vaccine became available for older adults in 2023. Medicare added it to the list of covered preventive services in 2024, which is why many people are only now learning they can get it without paying.

Key Takeaways

  • Medicare Part B covers both RSV vaccines (Arexvy and Abrysvo) at no cost for adults 60 and older.
  • You need a doctor's order to receive the vaccine; Medicare does not cover it if you get it at a pharmacy without a prescription.
  • The shot is given once, in a doctor's office or clinic, and requires no prior approval from Medicare.
  • If you have a Medigap or Medicare Advantage plan, your coverage remains the same because Part B is doing the paying.

How to get the RSV vaccine through Medicare

Call your primary care doctor's office and ask whether they have the RSV vaccine in stock and whether your doctor recommends it for you. Some offices order it on request; others keep it on hand. Mention that Medicare covers it at no cost so the office staff knows to bill Medicare directly.

At your appointment, bring your Medicare card. The doctor will review your medical history — particularly any lung disease, heart disease, or weakened immune system — and decide whether the vaccine is right for you. If yes, the nurse administers the shot that same visit. The office bills Medicare Part B, and you owe nothing.

If your doctor's office does not have the vaccine, ask for a referral to a clinic or pharmacy that does. Some pharmacies (like CVS and Walgreens) also stock the RSV vaccine, but only if you have a doctor's written order. A pharmacy cannot give you the shot without a prescription.

What happens if you have a Medicare Advantage plan

Medicare Advantage plans (Part C) must cover the same preventive services that Original Medicare covers, including the RSV vaccine. You should pay nothing out of pocket, just as you would with Original Medicare. However, you may need to use a provider in your plan's network, so check your plan documents or call the plan before scheduling.

Some Medicare Advantage plans require you to get the vaccine at a specific clinic or through a preferred pharmacy. If you go out of network, you may be charged. Call your plan's customer service number (on the back of your card) and ask which providers near you have the RSV vaccine and are in your network.

Medigap coverage and the RSV vaccine

If you have Original Medicare plus a Medigap policy, your Medigap plan does not pay for the RSV vaccine — Medicare Part B does. Medigap plans cover copays and coinsurance that you would otherwise owe, but since Medicare covers the vaccine at no cost, there is nothing for Medigap to pay. You owe nothing either way.

This is true for all Medigap plans (A through N). The vaccine is a preventive service, and Medicare's coverage of preventive services is always at no cost to the beneficiary.

Who should talk to their doctor about the RSV vaccine

The RSV vaccine is recommended for all adults 60 and older. However, your doctor may especially recommend it if you have chronic lung disease (like COPD or asthma), heart disease, diabetes, a weakened immune system, or a history of severe respiratory infections. If you live in a nursing home or assisted living facility, your facility may offer the vaccine on-site.

If you are 60 or older and have not had the RSV vaccine, there is no harm in asking your doctor about it at your next visit. The decision is between you and your doctor, and Medicare will cover it if your doctor prescribes it.

Common reasons the vaccine might not be covered

Medicare will not cover the RSV vaccine if you do not have a doctor's order. If you walk into a pharmacy and ask for the shot without a prescription, the pharmacy may refuse to give it or may bill you directly. Always get a prescription from your doctor first.

If you are under 60, Medicare does not cover the vaccine. Some younger people with severe immune problems may be able to get it through Medicaid or a private insurance plan, but Medicare Part B does not cover it for anyone under 60.

If you are not yet on Medicare (for example, you are still working and have employer coverage), your employer plan may or may not cover the RSV vaccine. Check your plan documents or call your benefits administrator.

What to do if your doctor's office says Medicare will not pay

If a doctor's office tells you that Medicare does not cover the RSV vaccine, ask them to double-check. This sometimes happens because the office staff is not yet familiar with the coverage. You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) and ask whether the RSV vaccine is covered under your plan.

If the office still refuses to bill Medicare, you can request an itemized bill and submit it to Medicare yourself. Keep a copy of your doctor's prescription and any receipt. Medicare's customer service line can walk you through the process if needed.

Frequently Asked Questions

Can I get the RSV vaccine at a pharmacy without seeing my doctor?

No. You need a doctor's written order (prescription) before any pharmacy or clinic can give you the RSV vaccine. Some pharmacies have pharmacists who can prescribe vaccines, but you would still need to speak with them first. Call ahead to ask whether the pharmacy offers this service.

Do I need to get the RSV vaccine every year like the flu shot?

No. The RSV vaccine is a one-time shot. You do not need boosters or annual doses. Once you have received it, you are done.

What if I already paid out of pocket for the RSV vaccine before I knew Medicare covered it?

You may be able to request a refund from the provider or submit a claim to Medicare for reimbursement. Contact the office or pharmacy where you received the vaccine and explain that Medicare should have covered it. Keep your receipt and any documentation of what you paid.

Can I get the RSV vaccine if I am allergic to any of the ingredients?

Tell your doctor about any allergies before your appointment. Your doctor will review the vaccine ingredients and decide whether it is safe for you. If you are allergic to any component, your doctor may recommend against the vaccine or suggest an alternative approach to protecting yourself from RSV.

Is the RSV vaccine the same as the COVID-19 vaccine or the flu vaccine?

No. The RSV vaccine is separate from the COVID-19 and flu vaccines. You can receive all three vaccines, but they are usually given at different times or in different arms. Ask your doctor about the timing if you need more than one vaccine at your visit.