Does Medicare Pay for RSV Vaccine?

Medicare does pay for the RSV vaccine in adults aged 60 and older.

David Minaya

January 17, 2024

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Each year, RSV causes 60,000-120,000 hospitalizations and 6,000-10,000 deaths in adults ages 65 and older . It infects the lungs and is a common cause of lower respiratory tract disease (LRTD). Furthermore, certain older adults are at high risk for severe cases of pneumonia or bronchiolitis. The good news is the FDA has approved two RSV vaccines for adults ages 60 and older – Abrysvo and Arexvy. Let’s get answers to your frequently asked RSV questions.

RSV FAQs

What is RSV?

RSV is a highly contagious Respiratory Syncytial Virus that causes infections of the lungs and breathing passages.

Why get the RSV Vaccine?

RSV vaccination was shown in clinical trials to have a moderate to high efficacy in preventing RSV-associated lower respiratory tract disease (LRTD).

Who is at high risk for severe disease caused by RSV?

Older adults with underlying health conditions , such as heart or lung disease or weakened immune systems, are at high risk for severe disease by RSV. Also, adults living in nursing homes or long-term care facilities have an elevated risk of severe RSV infection.

Where can you get the RSV shot?

You can get the RSV shot at your doctor’s office and local pharmacy .

Can you take the RSV shot with other vaccines?

Yes, it’s safe to get the RSV shot with other vaccines, such as COVID-19 booster and flu shot.

Medicare Coverage for RSV Vaccine

According to Medicare.gov , Medicare Part D covers all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP ), including RSV. On June 21, 2023, the ACIP recommended a single dose of RSV Vaccine for persons aged 60 or older. People new to Medicare can enroll in a Part D drug plan. Furthermore, during certain Medicare enrollment periods, you can change your Part D plan. Call Senior Healthcare Direct at 1-833-463-3262 and speak with a licensed agent.

Medicare Costs for RSV Vaccine

Medicare beneficiaries with Part D usually pay nothing out of pocket for the RSV shot. Furthermore, you pay no copayment or deductible for this ACIP-recommended vaccine. If an RSV shot isn’t on your plan’s drug list (formulary), you can call your plan and ask for a coverage exception. You can also pay for the shot upfront. Then, follow up with your plan to get reimbursed . The Medicare plan must pay you back if you paid for the RSV vaccine out of pocket.

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