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.
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.