It’s time to plan your flu season prevention strategy now; Medicare and Medicaid will cover the cost of most flu shots

Calendar Icon Updated January 17, 2019

Flu season is fast approaching and one of the more simple preventative measures every person can take is to get a flu shot as their first and most important step in protecting themselves against the flu virus.  A flu vaccination can reduce flu illnesses, the amount of time you miss from work and school, and make it less likely you will develop a serious case that could lead to hospitalization.

Influenza can be a serious health threat especially for vulnerable populations such as people who are 65 and older or who are at high risk due to pre-existing conditions such as diabetes or chronic heart disease issues.

The Centers for Disease Control and Prevention (CDC) recommends flu shots for everyone 6 months or older every year.  It’s also best to get your vaccination by the end of October if possible to give you maximum protection from the flu year ahead. 

For people enrolled in Medicare and Medicaid, the good news is that in most instances, the cost of a flu shot will be covered.  However, there are exceptions.

For Medicare beneficiaries, Medicare Part B will cover one influenza vaccination each flu season.  Medicare may also coverall additional vaccinations if medically necessary.

Medicaid also plays a key role in flu prevention by providing access to vaccines as well.  All children who are under 21 and eligible for Early and Periodic Screening Diagnostic and Treatment receive all recommended vaccines, including the flu vaccine.  The federally funded Vaccines for Children program provides vaccines at little or no cost for children enrolled in Medicaid, and those who are uninsured, underinsured or who are American Indians or Alaska Natives.  Children enrolled in Medicaid receive the vaccinations at no cost.  Other qualified groups must pay a small administration fee to cover the doctor’s cost to administer the vaccination.  Administration fees will vary by state.

Most state Medicaid agencies cover some adult immunizations, but not all offer vaccines as recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP).  Officials are working to identify gaps in coverage and develop recommendations to improve vaccination rates in adults. 

In the case of adults, states have broad discretion where preventive services coverage and payment are concerned. Coverage can be provided for all ACIP-approved vaccines as a discrete preventive service.  In addition, even where there is no coverage as part of an approved state plan, vaccines can be covered if a state will pay for the vaccine and its administration as an incidental procedure in certain office visits or as part of an institutional payment.

The bottom line is if you are not sure if you are covered for a flu vaccination through Medicaid in your state, it is best to check with officials if cost remains a concern for you.

The CDC also has several recommendations that everyone can take to best protect themselves and their families from influenza:

  • People at high risk of serious flu complications should take extra care in getting a flu vaccine.  These high risk groups include young children, pregnant women, people 65 years and older, and people with certain chronic health conditions such as asthma, diabetes, lung disease or heart disease. 
  • Children under 6 months old are also at high risk of serious flu illness, but are too young to be vaccinated.  Instead, people who care for infants should vaccinated.  In addition, all health care workers should be vaccinated as well as other people who live with or care for people in high risk categories.
  • Try to avoid close contact with someone who has the flu.  If you are sick, limit the amount of time you spend around others to keep from infecting them. 
  • If you have the flu, stay home for at least 24 hours after your fever is gone without the use of fever reducing medicines.
  • Cover your nose and mouth with tissue as you cough or sneeze.  Throw the tissue away immediately.  Wash your hands often with soap and water.
  • Avoid touching your eyes, nose and mouth to keep from spreading germs.
  • Be aggressive in disinfecting surfaces and objects that may become contaminated with flu germs.
  • If you get the flu, your doctor can prescribe antiviral drugs that are different from antibiotics and not available over-the-counter.  These drugs can make the illness milder and shorter, as well as help prevent serious flu complications.  Antiviral drugs work best when they are started within two days of getting sick, but can still be helpful even if they are started later.

For more tips, you can also review the CDC’s pamphlet on preventative actions to take against the flu.


Bret Colson

For more than a decade, he managed the city government public information and marketing activities for Anaheim, California, including an active role in the build-out of more than $5 billion in community and infrastructure improvements.  He also spent several years managing the public information function for an Orange County, California special district that served the needs of more than 1.6 million people, and has consulted for several local governments and private sector companies throughout the course of his career.

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