As fall begins, so does cold and flu season. To fight it, millions of people head to their local pharmacies to get vaccinated. This year, though, things might look a little differently. It was reported by multiple news organizations that several seniors on Medicare claim they were unable to get the newly released COVID shot, despite the fact that it’s currently only available to adults over the age of 65 and people with a severe medical condition. We share everything you need to know about this update, including details on if Medicare covers COVID vaccine shots and whether or not experts think seniors need this latest shot below.
Does Medicare cover COVID shots?
Medicare is a health insurance program meant for people 65 and older, people with disabilities, people with Amyotrophic Lateral Sclerosis (ALS) and people with End-Stage Renal Disease (ESRD). It’s funded by the government and is divided into four distinct parts, each of which aims to cover a different health related issue. Vaccines fall under Part B—which covers all necessary medical services—and Part D—which covers optional prescription drug charges.
As of publication, the COVID vaccine is still considered a necessary medical expense, meaning that, in theory, Medicare should cover it.
“A COVID-19 vaccine helps reduce the risk of illness from COVID-19 by working with the body’s natural defenses to safely develop immunity (protection) against the virus. Medicare covers the updated 2024-2025 Pfizer or Moderna vaccine for people five and older,” the December 2024 Medicare fact check sheet reads. “You pay nothing for the COVID-19 vaccine if your doctor or other health care provider accepts assignment for giving you the shot. You can get an updated vaccine from the same COVID-19 manufacturer that you got your original shot from, or choose to get it from a different manufacturer.”
The Medicare fact sheet also shared that “Your provider can’t charge you for an office visit or other fee if the vaccine is the only medical service you get. If you get other medical services at the same time you get the COVID-19 vaccine, you may owe a copayment or deductible for those services.”
What to do if your insurance won’t cover your vaccine
If Medicare or any other health insurance provider won’t cover the cost of your vaccine, there are a few things you can do according to experts.
“If your pharmacy resists giving you the vaccine, talk to your doctor about options. In some states, you may need a doctor’s prescription to have the injection covered,” Sharona Hoffman, author of Aging With a Plan and the co-director of the Law-Medicine Center told Woman’s World. “Medicare should cover the vaccines. However, if for some reason, it doesn’t, you should be able to obtain the vaccine by paying for it out of pocket.”
But it’s not cheap: According to Hoffman, pharmacies are charging as much as $175 to $225 for the shot. To lower the cost, many people are turning to GoodRX, to find coupons that drop the price to $83 and up. People with a FSA or HSA can use these funds to pay for vaccines too.
Is the COVID vaccine still needed for adults 65 and older?
As of publication, medical professionals say adults 65 and older should continue to receive the COVID-19 vaccine when they become eligible for it.
“COVID-19 is still an important cause of hospitalization and death. The vaccines are one of the best tools we have for preventing severe respiratory effects from a COVID infection,” Sylvie Stacy, MD, Medical Officer for Rehab.com, told Woman’s World. “For older adults, the rate of COVID-associated hospitalization and death is higher than in any other age group. So it’s really important that people with Medicare get the vaccine. In fact, they should get at least one booster dose, too, since that further decreases your chances of both infection and severe disease from complications of the infection.”
Hoffman adds that vaccination is important, and if coverage gaps cause older adults to skip their shot, it will have an adverse effect on public health. “We are likely to see more severe disease, hospitalization and even deaths,” she said. “Vaccines continue to be an essential tool in combatting COVID-19 and protecting public health, especially among seniors.”
