Does Medicare cover the RSV vaccine? Any details?

Medicare Forum
1

I was wondering if Medicare covers the RSV vaccine? I know it’s recommended for older adults, but I’m not sure how it works with Medicare.

2

Yeah, Medicare Part D covers the RSV vaccine. There shouldn’t be any copay or coinsurance for it since it’s part of preventive care.

3

Jesse said:
Yeah, Medicare Part D covers the RSV vaccine. There shouldn’t be any copay or coinsurance for it since it’s part of preventive care.

Oh cool, thanks! So, does that mean Original Medicare doesn’t cover it at all?

4

@Peyton
Exactly, Original Medicare doesn’t cover it. You need to have Part D prescription drug coverage or a Medicare Advantage plan that includes drug coverage to get it paid for.

5

I heard that RSV can be pretty serious for older adults. Anyone know more about that?

6

Linden said:
I heard that RSV can be pretty serious for older adults. Anyone know more about that?

Yeah, RSV usually just feels like a cold, but for some people, especially older adults, it can get worse. It can lead to pneumonia or heart failure, and some people end up in the hospital. According to the American Lung Association, thousands of older adults die from it every year.

7

@Davi
Wow, I didn’t realize it could be that bad. Definitely seems like a good idea to get the shot then.

8

How often do you need to get the RSV vaccine?

9

Wilder said:
How often do you need to get the RSV vaccine?

Just once every two years or so, according to the CDC. The best time to get it is in late summer or early fall, so you’re covered for the winter seasons when RSV is more common.

10

Do Medicare Advantage plans cover the RSV vaccine too?

11

Kirby said:
Do Medicare Advantage plans cover the RSV vaccine too?

Yes, if your Medicare Advantage plan includes prescription drug coverage, it’ll cover the RSV vaccine. If your plan doesn’t include drug coverage, then your standalone Part D plan will cover it.

12

@Teo
Got it. Thanks for clarifying.