Medicare covers the RSV vaccine for adults 60 and older, with no out-of-pocket cost to you

If you are 60 or older and enrolled in Medicare Part B, you can receive the RSV vaccine at no cost. Medicare began covering RSV vaccines in 2023 after the Food and Drug Administration approved them for older adults. The vaccine protects against respiratory syncytial virus, a respiratory illness that can be serious for seniors.

You do not need to pay a copay, coinsurance, or deductible for the RSV vaccine when you receive it at a Medicare-participating provider. This coverage applies whether you get the shot at your doctor's office, a pharmacy, or a clinic. The vaccine itself and the administration are both covered.

Key Takeaways

  • Medicare Part B covers the RSV vaccine for adults 60 and older at no cost to you.
  • You can receive the vaccine at any Medicare-participating provider, including doctors' offices, pharmacies, and clinics.
  • There are currently two RSV vaccines available: Arexvy and Abrysvo, and Medicare covers both.
  • You do not need a referral from your primary care doctor to get the vaccine.
  • If you have both Medicare and Medicaid, coverage rules may differ depending on your state.

Which RSV vaccines does Medicare cover

Two RSV vaccines are currently available and covered by Medicare: Arexvy (made by GSK) and Abrysvo (made by Pfizer). Both are single-dose vaccines given as an injection into the upper arm. Your doctor or pharmacist can discuss which vaccine may be right for you based on your health history.

Medicare covers both vaccines equally, so cost is not a factor in choosing between them. If you have a preference or if one vaccine is more readily available at your preferred provider, you can discuss that with your healthcare provider. The protection offered by both vaccines against RSV is similar.

Where to get the RSV vaccine

You can receive the RSV vaccine at any provider that accepts Medicare, including your primary care doctor's office, urgent care clinics, pharmacies with vaccination services, and hospital outpatient departments. Many pharmacies such as CVS, Walgreens, and Rite Aid offer RSV vaccines to Medicare beneficiaries. You can call ahead to confirm the vaccine is in stock and to schedule an appointment if you prefer.

When you arrive for your appointment, bring your Medicare card. The provider will verify your coverage and administer the vaccine. No referral is needed — you can walk in or schedule an appointment directly with any Medicare-participating location.

What happens if you have both Medicare and Medicaid

If you are enrolled in both Medicare and Medicaid (sometimes called "dual may be able to access"), Medicare is your primary payer for the RSV vaccine. Medicaid does not bill you for any remaining cost. However, coverage rules vary by state, so if you have questions about your specific situation, contact your state Medicaid office or your plan.

If you are enrolled in a Medicare Advantage plan (Part C) instead of Original Medicare, your plan must cover the RSV vaccine at no cost to you, just as Original Medicare does. Check your plan's materials or call the plan directly if you want to confirm which providers in your area offer the vaccine.

Timing and who should consider the vaccine

There is no specific time of year you must receive the RSV vaccine. You can get it any time during the year. Some people choose to get it in the fall or early winter when respiratory illnesses are more common, but this is a personal choice. You only need one dose of the RSV vaccine — it is not an annual shot like the flu vaccine.

The RSV vaccine is recommended for all adults 60 and older. It may be especially important if you have chronic heart or lung disease, a weakened immune system, or live in a setting with other people (such as a senior living community). Talk with your doctor about whether the vaccine is right for you, particularly if you have serious health conditions or take medications that affect your immune system.

What to expect after getting the vaccine

Most people have mild side effects or none at all. Common reactions include soreness, redness, or swelling at the injection site, and some people report mild fatigue or muscle aches for a day or two. These reactions are normal and usually go away on their own within a few days.

Serious side effects are rare. If you experience severe allergic reaction symptoms — such as difficulty breathing, swelling of the face or throat, or chest pain — seek when ready medical attention. Report any side effects to your doctor or to the Vaccine Adverse Event Reporting System (VAERS) at vaers.hhs.gov.

Frequently Asked Questions

Do I need to pay anything out of pocket for the RSV vaccine?

No. If you have Medicare Part B and are 60 or older, the vaccine and administration are covered at no cost. You should not receive a bill. If you do receive a bill, contact your provider and Medicare to report it.

Can I get the RSV vaccine at the same time as other vaccines?

Yes. You can receive the RSV vaccine at the same visit as your flu shot, pneumococcal vaccine, or other vaccines. Your provider can give multiple vaccines in one appointment. There is no waiting period between the RSV vaccine and other shots.

What if my doctor says I should not get the RSV vaccine?

If you have a severe allergy to any ingredient in the vaccine or have had a severe reaction to a previous dose, you should not receive it. Discuss your medical history with your doctor before the appointment. Your doctor can review whether the vaccine is safe for you based on your specific health situation.

Is the RSV vaccine covered if I am under 60?

Medicare does not cover the RSV vaccine for adults under 60. If you are younger than 60 and interested in the vaccine, ask your doctor whether it may be right for you and whether your health insurance covers it. Coverage varies by insurance plan.

How do I find a provider near me that offers the RSV vaccine?

Call your doctor's office or local pharmacy and ask if they offer the RSV vaccine to Medicare beneficiaries. You can also visit vaccines.gov and enter your zip code to find nearby vaccination sites. Medicare.gov's provider search tool can also help you locate participating providers in your area.