Yes, Medicare covers the RSV vaccine at no cost to you. The Inflation Reduction Act eliminated out-of-pocket costs for all recommended adult vaccines under Medicare Part D, including the RSV vaccine. That means no copay and no deductible.
How Medicare Covers the RSV Vaccine
The RSV vaccine is covered under Medicare Part D, which is the prescription drug benefit. This is different from flu and pneumonia shots, which fall under Part B. The distinction matters because Part D coverage depends on having a standalone Part D plan or a Medicare Advantage plan that includes drug coverage. If you have either of those, the RSV vaccine is fully covered.
Before 2023, Part D vaccines could still come with copays or require you to meet a deductible first. The Inflation Reduction Act changed that. Starting January 1, 2023, all vaccines recommended by the CDC’s Advisory Committee on Immunization Practices became free under Part D, with no cost-sharing and no deductible. In 2023 alone, 10.3 million Part D enrollees received a recommended vaccine at no charge, saving more than $400 million in out-of-pocket costs. The RSV vaccine accounted for the majority of those vaccinations.
Who Should Get the RSV Vaccine
The CDC recommends a single dose of RSV vaccine for all adults 75 and older. If you’re between 50 and 74, the vaccine is recommended only if you have certain conditions that raise your risk of severe RSV illness. Those include:
- Chronic heart disease such as heart failure or coronary artery disease (high blood pressure alone doesn’t qualify)
- Chronic lung disease including COPD, emphysema, asthma, or interstitial lung disease
- Kidney disease requiring dialysis or other replacement therapy
- Complicated diabetes that has caused kidney damage, nerve damage, or eye damage, or that requires insulin
- Neurologic or neuromuscular conditions that weaken respiratory muscles or impair the ability to clear the airway
- Chronic liver disease such as cirrhosis
- Severe obesity with a BMI of 40 or higher
- Weakened immune system from illness or medication
- Living in a nursing home
Your healthcare provider can also recommend the vaccine if they believe another condition or circumstance puts you at higher risk, such as frailty or living in a remote area where getting to a hospital quickly would be difficult. You don’t need medical documentation to prove you have a qualifying condition. Simply telling the vaccinator that you have a risk factor is sufficient.
Where to Get the Shot
You can receive the RSV vaccine at your doctor’s office or at a local pharmacy. Both settings bill through Part D, so you should pay nothing either way. If you have a Medicare Advantage plan with drug coverage, the same zero-cost rule applies. Call your pharmacy or provider ahead of time to confirm they have the vaccine in stock, since availability can vary by location and season.
How Many Doses You Need
The current CDC recommendation is for a single dose. The RSV vaccine is not an annual shot like the flu vaccine. One dose provides protection, though guidance on whether a booster will eventually be recommended could change as more long-term data becomes available.
What If You Don’t Have Part D
If you have Original Medicare (Parts A and B) without a Part D plan, the RSV vaccine is not covered. Part B covers certain vaccines like flu, pneumonia, and hepatitis B, but the RSV vaccine is not among them. Without Part D or a Medicare Advantage plan that includes drug coverage, you would need to pay the full retail price out of pocket. If you’re in this situation, enrolling in a Part D plan during the next open enrollment period would give you access to the vaccine at no cost along with broader prescription drug coverage.