Medicare is low-cost federal health insurance for U.S. adults over the age of 65. Different Medicare plans have different benefits. People enrolled in Medicare Part D (for prescription drugs) are covered for the RSV vaccine, but people who do not have Part D are not. Part B Medicare covers the flu and COVID-19 vaccines but does not cover the RSV vaccine. Visit medicare.gov to find the best plan for you.

There are different Medicare plans for people over age 65. These include Medicare Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D, a prescription drug coverage plan. These plans each have different costs per month and differ in what they cover. For more info on these plans, visit medicare.gov.

Medicare Part B, or the Medical Insurance Plan covers the cost of some preventative vaccines including vaccines for the flu, COVID-19, Hepatitis B, and pneumonia. It does not currently cover the cost of the RSV vaccine.

Medicare Part D includes prescription drug coverage and additional vaccines that are recommended by a primary care doctor or national guidelines. This includes the RSV vaccine for people over age 60. As of January 2023, these vaccines are available to covered patients at no out-of-pocket cost or co-pay because of the Inflation Reduction Act.

People who do not have other health insurance, who do not have Medicare Part D, or are not yet eligible for Medicare (under age 65) may have to pay out-of-pocket costs for the RSV vaccine.

Medicaid should cover RSV vaccinations for those enrolled who are between the ages of 60-64 if it is recommended by their doctor according to Medicaid.gov.

Medicare enrollment, including enrollment for Part D, is open from October 15, 2023 through December 7, 2023.

Some insurance companies are still updating their policies around no out-of-pocket costs for recommended vaccines after the Inflation Reduction Act. We are still learning how patients are being affected by delays and confusion with these changes.

There are varied reports of how much people are paying out of pocket for the RSV vaccine if they don’t have an insurance plan that covers it.