RSV, short for respiratory syncytial virus, is a common respiratory infection that causes mild, cold-like symptoms in most people. While the virus usually clears up in about a week, certain groups are at higher risk of developing severe complications.
Thankfully, there are currently two RSV vaccines approved by the Food and Drug Administration to help people protect against the virus: Arexvy by GlaxoSmithKline and Abrysvo by Pfizer.
The Centers for Disease Control and Prevention recommends vaccination for higher-risk populations, particularly those ages 60 and older.
“Those over 60 should be very concerned about contracting RSV,” says Dr. Roopa Anmolsingh, a geriatrician at the Cleveland Clinic’s Center for Geriatric Medicine in Ohio. “Due to RSV, around 6,000 to 10,000 older adults die annually. Older persons also often have chronic conditions — such as (chronic obstructive pulmonary disease), asthma and heart disease — which may worsen with severe RSV.”
Given how serious the illness can be in certain populations, it’s important to make sure people are protected from getting RSV and have access to the vaccine through their insurance.
Here’s what you need to know about Medicare coverage of the RSV vaccine.
[READ What You Should Know About the RSV Vaccines]
Medicare Coverage
The RSV vaccine is covered by Medicare under Part D (drug coverage) with no out-of-pocket costs, but be sure to always check with your plan first.
While Medicare covers vaccines — including vaccines for the flu, pneumonia, hepatitis B and COVID-19 — under Part B (medical insurance) to treat exposure to a disease, Part D covers all vaccines to prevent illness that the Advisory Committee on Immunization Practices recommends, except those covered by Part B.
Any vaccine administration fee at the time of service is reimbursable through Medicare. If, when you go to get the vaccine you are told otherwise, you should call 1-800-MEDICARE for assistance.
Medicare Advantage plans (Part C) typically cover the RSV vaccine, but the coverage details may vary depending on each plan. Contact your Medicare Advantage plan or look at the summary of benefits before you make an appointment to find out exactly what is covered. They can provide details on any associated costs or copayments, as well as where you can receive the vaccine within the plan’s network.
[Related:Does Medicare Cover the Shingles Vaccine?]
Avoiding Transmission
Like many viruses, RSV is transmitted through the air and can survive on surfaces for several hours. In addition to vaccination, you can lower your risk of contracting the virus by avoiding contact with those who are sick, washing your hands frequently and being aware of what you touch while you are out in public.
[READ: The Differences Between RSV, COVID and the Flu Symptoms]
Bottom Line
RSV often presents as a mild illness resembling a cold, but can pose certain health risks, especially for individuals over ages 60 and those with chronic heart or lung conditions. That’s why it’s important for high-risk individuals to take precautions and protect themselves (and others) by getting vaccinated.
You will be able to receive the RSV vaccine if you have a Medicare Part D plan. For Medicare Advantage plan beneficiaries, chances are that the RSV vaccines are fully covered, but some plans have differing benefits, so ask your plan if RSV vaccines are included.
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Does Medicare Cover the RSV Vaccine? originally appeared on usnews.com
Update 11/14/24: This story was previously published at an earlier date and has been updated with new information.
