If You’re On Medicare, Here’s What You Should Know About The Flu Shot

The flu season is coming. We don’t know exactly when it will arrive or how long it will last but it’s on its way. In the United States, flu season generally begins in October, peaks between December and February, and extends into May. 

Every year, the arrival of the flu presents a risk for seniors. People 65 years and older account for 70 to 85% of flu-related deaths and 50 to 70% of flu-related hospitalizations each flu season. However, this year the risk is considerably greater because of the pandemic. Eight of 10 COVID-19 related deaths have been among those 65 and older. Getting the flu or COVID is serious but getting both can be deadly. 

There’s an even greater concern: the burden that the flu might add to already overloaded hospitals. Through mid-September, almost 400,000 have been hospitalized with COVID-19. In the last five years, flu-related hospitalizations ranged from a low of 280,000 in the 2015/16 season to a high of 810,000 in 2017/2018. Hospitals are already struggling to care for the patients they have. How could they meet the demands created by both of these illnesses? And would you want to be a patient in times such as these?

We should all know by now that good infection control practices, such as handwashing, wearing face masks, social distancing and staying home when sick, can prevent the spread of flu and COVID-19 and lower our risk. However, with the flu, we have another important weapon – a vaccine. It’s available but not everyone gets a flu shot. Depending on the reporting source, between 54% and 68% of those over age 65 got the flu shot in the 2018 season. This year, we’ve got to do better. If you have not gotten a flu shot in the recent past, get one this year. And, if you’re vaccinated every year, continue the practice. 

10 important points about Medicare, the flu, and the flu vaccine 

1. Flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and sometimes the lungs. These diseases are transmitted through coughing, sneezing or talking.
2. Flu symptoms can mirror COVID-19. Fever, cough, shortness of breath, sore throat, muscle aches, headache and runny or stuff nose are common symptoms for both. If you get any of these, don’t guess what you have; contact your physician. 
3. Most should get a flu shot but some should not. The Centers for Disease Control and Prevention (CDC) recommend all persons aged six months of age and older get the annual vaccination, with rare exceptions. For example, those who have a life-threatening allergy to eggs or gelatin should consult their physicians.  
4. The CDC recommends getting the vaccine in early fall before flu season begins. However, older persons should get the vaccine in the month of October. This may help ensure that the vaccine doesn’t lose effectiveness as the peak of flu season approaches. 
5. Medicare pays for the flu shot. Original Medicare Part B will cover the vaccination with no deductible or copayment. Medicare Advantage plans must also pay for the shot. 
6. Doctors can administer the vaccine. If you have Original Medicare, you can get the flu shot at the office of any doctor who accepts Medicare assignment. Those with Medicare Advantage will probably need to visit a doctor in network in order for the plan to pay.  
7. It’s likely every pharmacy in your neighborhood can also administer the vaccine. A pharmacy can bill for the flu vaccine if it’s enrolled in the Medicare program and able to submit the claim, or if it’s included in the Medicare Advantage plan’s network. 
8. You won’t have to wait in line this year. To help maintain social distancing, many pharmacies are taking appointments for the flu shot. Check out your favorite pharmacy online, book a date, complete the paperwork, and show up at your scheduled time. Two suggestions: One, call ahead to make sure the pharmacy has the vaccine available. When a friend went to her appointment, she learned the shelves were empty. As the pharmacist said, there’s a big demand this year. Two, remember to take your red, white and blue Medicare card or your Medicare Advantage card. While waiting to check in for my shot, a man was turned away because he didn’t have his card and the pharmacy could not bill for the vaccination.
9.  Consider the high-dose vaccine. Available for those over 65, this contains four times the antigen as other vaccines. The higher dose of antigen helps older people develop a better immune response and protection against flu. 
10.  Side effects are generally temporary and mild. These can include pain, redness or swelling at the injection site, headache, muscle ache and malaise (simply not feeling well), and they typically resolve with one to three days.

Get the flu shot this year. Maybe a little pain but you’ve got a lot to gain.