A health professional administers a Medicare flu shot to a patient.

As a Medicare beneficiary, you may wonder whether your coverage includes the seasonal influenza vaccine, commonly referred to as a flu shot. As long as the doctor or qualified healthcare provider accepts Medicare, your Medicare flu shot will be covered once each flu season at no cost to you. HealthMarkets can help you learn how your shot will be covered, and why you should take advantage of your free yearly flu shot.

How Do I Know Whether My Doctor Accepts Medicare?

Before you get a Medicare flu shot, check that your medical provider accepts your coverage. If your doctor accepts Medicare assignment, they are “participating.” That means he or she agrees to accept the Medicare-approved payment amount for covered services. The only way to know for sure whether your doctor accepts Medicare assignment is to ask them.

If your doctor accepts assignment:

  • They won’t charge you more than the Medicare-approved amount for any covered service. This agreement means your out-of-pocket expenses may be less expensive than if you go to a doctor who doesn’t accept assignment.
  • The only fees you need to consider are your Medicare deductible and any applicable copayment. (But your flu shot will be covered without these fees applying.)
  • Your doctor agrees to forward your claim to Medicare and not charge you for doing so.

If your doctor doesn’t accept assignment:

  • They haven’t entered into an agreement to accept the Medicare-approved amount for all covered services. However, they can still choose to for any particular service. Keep in mind that nonparticipating doctors may ask you to pay the whole bill out of pocket.
  • The doctor can charge you more than the Medicare-approved amount. There is a “limiting charge” that restricts this increase to 15% more than the approved amount on certain Medicare services.
  • Your doctor should still submit your claim to Medicare without charging you for doing so.*

Medicare Flu Shots Are Covered, But Why Should I Get One?

According to the Center for Disease Control (CDC), everyone 6 months and older should get a flu shot every season, with limited exceptions. Please consult with a medical professional to receive further guidance. Your yearly Medicare flu shot will be covered 100% by your Medicare insurance plan as a preventive service to avoid sickness, so getting the shot will cost you nothing.

HealthMarkets Can Help You Find Medicare Coverage

HealthMarkets can help you review your Medicare plan options, at no cost to you. Call (800) 488-7621 today to speak to a licensed insurance agent or get started comparing plans online now.

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References

*There are some cases when you’ll need to submit your own claim to receive reimbursement.

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