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Influenza Treatment, Pneumonia Treatment, and Medicare: What Medicare Benefits Are There for Those With Influenza and Pneumonia?

Will Medicare cover influenza treatment?

Just the Essentials:

  • It’s possible to get the flu year-round, but infections spike in the fall and winter.

  • Contracting the flu can cause dangerous complications, such as the onset of pneumonia.

  • Getting influenza and pneumococcal vaccines are vital to your health during this time.

  • Aim to get your flu shot during the month of September, but no later than the end of October, for it to work best.

  • Influenza and pneumococcal vaccines are covered by Medicare Part B and Medicare Advantage plans.

What Medicare coverage is available for pneumonia treatment?

Flu Season is On the Way: Are You Ready?

As a senior, the flu poses a strong threat to you any time of the year. No matter how healthy you are, the influenza virus can cause serious damage to your body if you opt to let it run its course without some type of influenza treatment. For instance, pneumonia in seniors is a very common complication of influenza infection. Once the illness reaches that point, it can be fatal if you don’t get some type of influenza or pneumonia treatment immediately.

Flu cases typically rise highest during the fall and winter, which has led these seasons to become one big de facto flu season. To reduce your chances of contracting influenza or pneumonia during flu season, it’s important to get influenza and pneumococcal vaccines to help you stave off and reduce the effects of each illness. In order for the influenza vaccine to work its best, you should get it sometime between the middle of September and the end of October.

For some of you, getting flu or pneumonia shots may be a little pricey. If you’re a senior living on a low fixed income, getting the influenza or pneumococcal vaccine may be low on your priority list if you feel that you can’t afford it. If you’re a Medicare beneficiary, however, there’s good news: these vaccines are covered if you have Medicare Part B or Medicare Advantage.

In this article, we’ll answer some of your most frequently asked questions about influenza treatment and pneumonia treatment. Some of the questions we’ll be answering include:

  • Does Medicare cover influenza treatment?
  • Does Medicare cover pneumonia?
  • How much of the costs for my flu or pneumonia shots will Medicare cover?

To learn more about treatment for influenza, pneumonia treatment, and Medicare coverage for both, keep reading!

Influenza and pneumonia in seniors.

Does Medicare Cover Influenza Treatment?

Influenza treatment goes beyond the influenza vaccine. If you’re afraid to get it because you feel like you may be allergic, or you’re nervous about the side effects, don’t worry: the vaccine isn’t necessary to avoid the illness, though it is the most effective way to keep it at bay. There are a few steps that you can take to avoid getting the flu, no matter whether you’ve received the vaccine or not, including washing your hands, staying home when sick, and avoiding contact with individuals who are or have been sick.

However, let’s say that you do get the flu. What kind of treatments can you get to keep it from worsening? Also, does Medicare cover these treatments? 

The key to keeping the flu from overwhelming your system is to have it treated early. Call your healthcare provider and go over your symptoms. This is crucial, because both influenza and the COVID virus have mirroring symptoms. Your physician will likely want you to come in for testing to make sure that what you’re suffering from is, indeed, the flu.

If you test positive for the flu, your healthcare provider may prescribe antiviral medications for you to take. Taking antivirals within 48 hours of onset of symptoms can help you feel better faster, and they can help you reduce the risk of serious complications. Antivirals can be a very important part of your treatment for influenza.

If you are prescribed antiviral medications for the flu, and you have a Medicare Part D Prescription Drug plan, your medications may be covered in part or completely. To make sure that the antiviral medications prescribed to you are covered, check your plan’s formulary. This will let you know how much, if anything, you’ll need to pay out-of-pocket (OOP) for your medications.

Your provider visit can be covered by either Medicare Part B or a Medicare Advantage plan, depending on which plan you have. The influenza test itself, however, is not covered by Medicare Part B. The test may be covered by a Medicare Advantage plan, but it’s important to check your plan’s literature, or to speak with your plan provider, ahead of time to be sure that flu tests are covered, should you need one.

Influenza vaccines, as mentioned earlier, are covered by both Medicare Part B and Medicare Advantage plans. Some Medicare Advantage plans may also provide allowances to help you pay for over-the-counter (OTC) remedies to help combat the flu virus. If the flu is a particular concern for you and you’re curious about Medicare Advantage plans that carry this benefit, research plans in your area and check with a licensed insurance agent to see if any plans near you meet this need.

Does Medicare Cover Pneumonia?

Developing pneumonia is, and should be, a key concern for seniors who contract influenza. Pneumonia in seniors is one of the most devastating complications of getting the flu. If not caught and treated quickly, pneumonia can be deadly.

One of the best ways to fight pneumonia is to get the pneumococcal vaccine. The vaccine can be given in a single dose, or over the course of two doses. If you’re worried about paying the cost, Medicare Part B, in most cases, will cover the cost of the pneumococcal vaccine once in your lifetime. If you have a Medicare Advantage plan, your pneumococcal vaccine should be covered as well.

If you do develop pneumonia, it’s crucial to visit a healthcare provider, and fast. Some signs to look for if you feel like you’re developing pneumonia include:

  • Coughing, either dry or “wet” – producing thick yellow, green, brown, or bloody mucus
  • Difficulty breathing
  • Rapid heartbeat
  • Chest pain
  • Wheezing
  • Joint and muscle pain
  • Confusion or disorientation, prevalent in pneumonia in seniors

Mild pneumonia doesn’t call for testing, and can usually be detected by your healthcare provider listening to your chest and back for crackling or rattling. This form of pneumonia can typically be treated at home with rest, prescription antibiotics, and fluids.

Let’s say that your pneumonia is more serious. Symptoms are getting worse, and this is after you’ve gotten treatment. Your provider will likely call for x-rays, a sputum test, or a blood test. Once pneumonia has progressed to this point, it may require hospitalization for extra treatment, especially if you’re a senior. Pneumonia in seniors can lead to very serious comorbidities, such as:

  • Lung abscesses
  • Pleurisy
  • Blood poisoning

If you develop mild pneumonia, your physician’s visit and the antibiotics may be covered in part or in full by both Medicare Part B (the visit) and Medicare Part D (the antibiotics). Tests to discover whether or not the pneumonia is worsening are not covered by Part B. However, these may be covered by a Medicare Advantage plan. Check with your plan carrier to determine whether or not your Medicare Advantage plan covers testing for pneumonia.

If your pneumonia requires hospitalization, the care that you receive in the hospital will be covered by Medicare Part A. It will also be covered by Medicare Advantage plans, as Medicare Advantage plans are lawfully required to cover the same treatments and services covered by both Part A and Part B (Original Medicare). 

With Part A, you’ll pay a $1,600 deductible for hospital care, with no copayment for stays up to 60 days. Stays from 61 days up to 90 days will require you to pay a $400 copayment for each day, and stays beyond day 90 up to 150 will require an $800 copayment for each day. After 150 days, you’ll be on the hook for all hospital costs.

To learn more about inpatient care coverage for hospitalization through your Medicare Advantage plan, check your plan’s literature. Also, if you’re still unsure, be sure to ask your plan carrier any questions. The licensed insurance agents working for your plan carrier are always happy to help.

Are influenza shots covered by Medicare?

Don’t Overlook Influenza Vaccines and Treatment

Influenza can be incredibly dangerous, especially to you as a senior. It’s very important to look into all forms of influenza treatment available to you, just in case you were to ever need them. Remember, Medicare will cover most influenza and pneumonia treatments and medications available. To learn more, check in with a licensed insurance agent with the expertise and knowledge to assist!

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