Medicare covers the RSV vaccine for adults 60 and older at no cost to you

If you are 60 or older and enrolled in Medicare Part B, you can receive the RSV vaccine without paying a copay, coinsurance, or deductible. Medicare began covering RSV vaccines in June 2023 after the Food and Drug Administration approved them for older adults. The vaccine protects against respiratory syncytial virus, which causes serious respiratory illness in older people and can lead to hospitalization.

You do not need a referral from your doctor to get the vaccine. You can walk into a pharmacy, doctor's office, or clinic that administers vaccines and ask for it. The provider will bill Medicare directly, and you will pay nothing at the point of service.

Key Takeaways

  • Medicare Part B covers one dose of RSV vaccine for adults 60 and older with no out-of-pocket cost.
  • You can receive the vaccine at your doctor's office, a pharmacy, or any clinic that stocks it — no referral needed.
  • The vaccine is most effective when given in the fall or early winter, before RSV season peaks.
  • If you have both Medicare and Medicaid, Medicaid will not pay for the vaccine because Medicare is your primary payer.

Which Medicare plans cover the RSV vaccine

All Medicare Part B plans cover the RSV vaccine. This includes Original Medicare (the federal program run by Centers for Medicare & Medicaid Services) and Medicare Advantage plans, which are run by private insurance companies but must cover everything Original Medicare covers.

If you have a Medigap supplemental plan, it does not need to cover the vaccine because Medicare Part B already covers it in full. Your Medigap plan will not be billed.

If you have only Medicare Part A (hospital insurance) and not Part B, you are not covered for the RSV vaccine. Part A does not cover outpatient vaccines. You would need to enroll in Part B or find another source of coverage.

Where to get the RSV vaccine

You can receive the RSV vaccine at any location that stocks it and is enrolled as a Medicare provider. Common places include:

  • Your primary care doctor's office
  • Pharmacies (CVS, Walgreens, Rite Aid, and others)
  • Urgent care clinics
  • Community health centers
  • Hospital outpatient departments

Not every location will have the vaccine in stock at all times. Call ahead to confirm the vaccine is available before you go. If your preferred location does not carry it, ask for a referral to a nearby provider that does.

You do not need an appointment at many pharmacies, but some doctors' offices require one. Check with your chosen location about their scheduling process.

What to bring when you get the vaccine

Bring your Medicare card so the provider can verify your coverage and bill Medicare correctly. You should also bring a photo ID and your insurance information card if you have a Medicare Advantage plan.

If you have received other vaccines recently (such as the flu or COVID-19 vaccine), tell the provider. The RSV vaccine can usually be given at the same visit as other vaccines, but your provider may want to space them out depending on which vaccines you have had.

Bring a list of any medications you take, especially if you have a weakened immune system or take immunosuppressant drugs. This information helps the provider decide whether the vaccine is right for you at this time.

Who should not receive the RSV vaccine

Most adults 60 and older can safely receive the RSV vaccine. However, you should tell your provider if you have had a severe allergic reaction to any ingredient in the vaccine in the past. Your provider can review the vaccine ingredients with you and decide whether it is safe to proceed.

If you are currently very ill with a fever or other acute illness, your provider may recommend waiting until you recover before getting the vaccine. This does not mean you can never have the vaccine — it means timing it when you are feeling better produces a better immune response.

If you have a severely weakened immune system due to cancer treatment, organ transplant, or certain medications, talk to your doctor before getting the vaccine. They can advise whether the vaccine is right for you and when to receive it.

Timing and RSV season

RSV circulates year-round but peaks in the fall and winter months in most of the United States. The best time to get the vaccine is September through November, before cases rise. However, you can receive the vaccine any time of year — it is never too late to protect yourself.

You only need one dose of the RSV vaccine. Unlike the flu vaccine, which you need every year, the RSV vaccine is a one-time shot. Medicare covers one dose per person, and you do not need to repeat it annually.

If you have both Medicare and another insurance

If you have Medicare and Medicaid, Medicare is your primary payer for the RSV vaccine. Medicaid will not cover it because Medicare already does. You will pay nothing out of pocket.

If you have Medicare and private insurance from an employer or spouse's employer, Medicare is still your primary payer for the vaccine. Your private insurance will not be billed. You will pay nothing.

If you have Medicare Advantage and a Medigap plan, your Medicare Advantage plan is your primary payer. The Medigap plan will not be billed because the vaccine is already covered in full.

Frequently Asked Questions

Do I have to get the RSV vaccine if I am over 60?

No. The vaccine is available to you at no cost, but it is not required. You and your doctor can decide together whether getting the vaccine makes sense for your health. If you have chronic lung disease, heart disease, or a weakened immune system, your doctor may recommend it more strongly.

What if I am 59 and will turn 60 soon — can I get the vaccine now?

Medicare coverage begins on the date you turn 60. If you are not yet 60, you would need to pay out of pocket or wait until your 60th birthday. Some state Medicaid programs or community health programs may cover the vaccine for people under 60, so you could call your local health department to ask about other options.

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

Yes. Having RSV in the past does not prevent you from getting the vaccine, and the vaccine can still protect you. RSV can infect you more than once in your lifetime, so the vaccine offers protection even if you have had the virus before.

What are the side effects of the RSV vaccine?

Common side effects are mild and temporary: arm soreness, fatigue, muscle aches, and low-grade fever. Most people feel back to normal within a day or two. Serious side effects are rare. Your provider will give you a fact sheet about the vaccine before you receive it.

If I get the RSV vaccine, do I still need the flu and COVID-19 vaccines?

Yes. The RSV vaccine protects only against respiratory syncytial virus. You still need the annual flu vaccine and COVID-19 vaccines (as recommended by your doctor) to protect against those separate viruses. You can receive all three vaccines at the same visit or at different times.