Medicare Part B covers the RSV vaccine for adults 60 and older

Yes, Medicare Part B covers the respiratory syncytial virus (RSV) vaccine for people age 60 and up. The vaccine became covered on June 21, 2023, after the Food and Drug Administration approved it for older adults. You pay nothing out of pocket for the vaccine itself if you receive it at a Medicare-enrolled provider.

The RSV vaccine is given as a single shot, usually in the arm. It protects against a respiratory virus that causes serious illness in older adults — particularly those with chronic heart or lung disease, weakened immune systems, or those living in group settings like nursing homes.

Coverage applies to two vaccines: Arexvy (made by GSK) and Abrysvo (made by Pfizer). Both are covered the same way under Part B. Your doctor can discuss which one may be right for you based on your health history.

Key Takeaways

  • Medicare Part B covers the RSV vaccine at no cost to you if you are 60 or older and receive it at a Medicare-enrolled provider.
  • You typically need a doctor's order to receive the vaccine, and it is given as a single injection.
  • The vaccine is covered whether you have Original Medicare or a Medicare Advantage plan, though Advantage plans may have different rules about where you can get it.
  • You should ask your doctor whether the RSV vaccine is right for you, especially if you have heart disease, lung disease, or a weakened immune system.

Where to get the RSV vaccine under Medicare Part B

You can receive the RSV vaccine at most places that give shots and accept Medicare, including your doctor's office, urgent care clinics, pharmacies, and hospital outpatient departments. Call ahead to confirm they have the vaccine in stock and that they accept your specific Medicare plan.

If you have Original Medicare, any Medicare-enrolled provider can give you the vaccine. If you have a Medicare Advantage plan, check your plan's provider directory or call the plan to find in-network locations. Using an out-of-network provider may cost you more.

Pharmacies like CVS, Walgreens, and Rite Aid often carry the RSV vaccine and accept Medicare. You can call your local pharmacy to ask whether they have it available and whether they accept your coverage.

What you pay for the RSV vaccine

Under Medicare Part B, you pay nothing for the vaccine itself. Part B covers the full cost of the shot after you meet your annual Part B deductible (which is $226 in 2024, though this amount changes each year).

Once you have met your deductible, Part B pays 80 percent of the cost of the vaccine administration — the fee for giving the shot. You pay the remaining 20 percent. If you have a Medigap or Medicare Advantage plan, your supplemental coverage may pay some or all of that 20 percent coinsurance.

If you have not yet met your Part B deductible for the year, you will pay the full deductible amount first, then your coinsurance for the vaccine administration.

RSV vaccine and Medicare Advantage plans

Medicare Advantage plans (Part C) must cover the RSV vaccine because they are required to cover everything Original Medicare covers. However, the details of your coverage — such as copays, coinsurance, or which providers you can use — depend on your specific plan.

Some Advantage plans may charge a copay for the vaccine or the administration fee, while others may cover it with no cost to you. Check your plan documents or call your plan's customer service line to learn your exact out-of-pocket cost before you get the vaccine.

If you use an out-of-network provider with a Medicare Advantage plan, you may pay more or the plan may not cover the vaccine at all. Always confirm that your provider is in-network before scheduling your appointment.

Should you get the RSV vaccine

The Centers for Disease Control and Prevention recommends the RSV vaccine for all adults 60 and older. However, the decision to get it should be made with your doctor, especially if you have certain health conditions.

You may have stronger reasons to get the vaccine if you have chronic heart disease, chronic lung disease (including asthma or COPD), diabetes, a weakened immune system, or if you live in a nursing home or other group setting. RSV can cause severe pneumonia and hospitalization in these groups.

Talk with your doctor about whether the RSV vaccine is right for you. Your doctor can review your medical history and help you weigh the benefits and any risks based on your individual health.

How to schedule your RSV vaccine appointment

Start by calling your primary care doctor's office to ask whether they have the RSV vaccine available and whether they can schedule you. Many doctors' offices have it in stock and can give it during a regular visit or a quick appointment.

If your doctor's office does not have the vaccine or cannot see you soon, call a local pharmacy or urgent care clinic. Ask whether they accept your Medicare coverage and whether the vaccine is in stock. You do not need a referral from your doctor to get the vaccine at a pharmacy, but some pharmacies may ask your doctor to send over your medical records.

Bring your Medicare card and any other insurance cards you have. The provider will verify your coverage before giving the vaccine.

Frequently Asked Questions

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

Most pharmacies and clinics can give the RSV vaccine without a standing doctor's order, similar to flu shots. However, some providers may ask your doctor to confirm it is appropriate for you based on your health history. Call ahead to ask what your provider needs.

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 other vaccines, such as the flu shot or pneumococcal vaccine. Your provider can give multiple vaccines in different arms during one appointment.

What if I have a Medicare Advantage plan instead of Original Medicare?

Your Medicare Advantage plan must cover the RSV vaccine, but your out-of-pocket cost may differ. Call your plan to learn your copay or coinsurance before you schedule. Make sure you use an in-network provider to avoid higher costs.

Is the RSV vaccine covered if I am under 60?

Medicare Part B covers the RSV vaccine only for people 60 and older. If you are younger than 60 and have Medicare (for example, due to disability), the vaccine is not covered. Ask your doctor whether it might be available through another program or insurance.

What side effects should I watch for after the RSV vaccine?

Common side effects include arm soreness, fatigue, and muscle aches for a day or two. Serious side effects are rare. Call your doctor if you have signs of an allergic reaction, such as difficulty breathing or swelling of the face, or if side effects do not improve within a few days.