Posted on November 18, 2022 by Austin Lang
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Posted on November 18, 2022 by Austin Lang
If you haven’t gotten your COVID vaccine boosters yet, there’s no time to waste. Autumn and winter are historically the peak season for Flu and COVID transmission, so getting your shot before the holiday festivities is critical. Currently, vaccines are still our best defense against severe illness.
Still, it’s fair to worry: does Medicare cover COVID booster vaccines? Fortunately, you don’t need to fret too much, but there are some things you should be aware of.
As part of the ongoing public health emergency, the COVID-19 vaccine is covered under Medicare Part B and Medicare Advantage, at no cost to you. This includes any boosters available to you. However, “no cost” and “free” aren’t the same things.
Medicare has a compensation schedule for COVID booster shots, covering about $40 per dosage. Providers must waive any additional fees if a COVID vaccine is the only service you receive. Contact your provider to clear up any billing errors if you are charged. If they persist in charging you, contact your plan provider.
Still, despite not costing you anything, there are rules about when you can get a COVID booster dose.
When it comes to the federal government, the Food and Drug Administration and your Medicare or Medicare Advantage plan, you’ve got options depending on your situation. If you have yet to receive your vaccine for any reason, you’ll need to undergo the primary series before getting a booster vaccine.
Moderna (Spikevax) and Pfizer-BioNTech (Comirnaty): These vaccines are very similar, using mRNA technology to trick your body into producing parts of the SARS-COV-2 virus that are incapable of causing infection, but similar enough to the real thing that your body can develop immunity. They’re the most common COVID vaccines in the United States.
You’ll require two doses of this vaccine, roughly 4-8 weeks apart. You’re eligible for a Moderna or Pfizer booster two months after your second dose. The booster should be of the same type as your original vaccine, though adults 18 and older can get a Novavax booster instead.
Johnson and Johnson (Janssen): J&J’s single-dose shot is a virus vector vaccine, similar to what you’d get for a flu shot. It contains a weakened version of the SARS-COV-2 virus, which allows your body to develop immunity to the disease.
This shot is relatively uncommon due to its lower efficacy than mRNA vaccines and the risk of causing blood clots in rare cases. You’re most likely to have received this vaccine in situations where receiving the mRNA vaccine was impractical or unfeasible, as its stable shelf temperature and single dose made it ideal for use in remote clinics, homeless shelters, and situations where people were unlikely to return for a second dose.
If you received this version of the vaccine, you are eligible for either a Moderna or Pfizer vaccine after four weeks, and a booster mRNA vaccine two months later.
Novavax (Nuvaxovid and Covovax): The newest vaccine on the market, Novavax is a protein adjuvant vaccine that contains no viral material. Instead, it contains nanoparticles that mimic the spike protein of SARS-COV-2, allowing your body to develop antibodies against the virus.
Novavax is almost as effective as mRNA vaccines, is more easily stored, and can safely be used in certain situations where using mRNA vaccines poses too high a risk. Your doctor may recommend a Novavax booster shot if you had an adverse reaction to, or if you have a medical condition that prevents you from receiving mRNA vaccines.
The initial dosage schedule is the same as for mRNA vaccines. You can receive a Novavax booster shot six months after your second dosage, or an mRNA booster shot two months after your second dosage. If you do not have a condition that prevents you from doing so, getting an mRNA booster dose is preferable, as they are more up-to-date with current strains of the virus.
COVID booster vaccines are available anywhere you would typically get a flu shot, including most pharmacies. You can use the official vaccine location finder to locate a provider near you. Be sure to bring your Medicare or Medicare Advantage card so the provider can properly bill Medicare for services.
If you are homebound, Medicare health insurance covers in-home vaccinations. Contact your health care provider for information on in-home vaccination services.
Stay home if you’re sick, even if you’re positive it’s not COVID. Vaccines work by triggering an immune system response, and doing so while your body is already fighting off infection can result in serious side effects. Plus, you don’t want to spread what you have to anyone else.
If you’ve recently had COVID, even if you were asymptomatic, it’s recommended that you wait three months following your initial symptoms/positive test result before getting a booster shot. Your natural immunity should protect you until then.
Long COVID symptoms should not prevent you from seeking a booster shot, and in fact may improve following vaccination. You can learn more about Long COVID and other COVID recovery benefits in our article on the subject.
Even though the pandemic continues to linger like the smell of garlic in your fridge, it will eventually come to an end. At that point, the public health emergency will be declared over, and many of the emergency provisions put in place will end. However, no-cost COVID vaccines are unlikely to go anywhere anytime soon.
While Medicare Part B does not cover many vaccinations, one it consistently covers is the flu shot, due to influenza’s endemic nature and high risk to seniors. In fact, most historic pandemics involved an influenza variant, with the Spanish Flu pandemic of 1918 being one of the most deadly.
SARS-COV-2, as a coronavirus, is very similar to influenza, though it is far more virulent and capable of causing more severe symptoms. As such, it is likely to follow a similar pattern, with cases dropping during the summer and spiking in the winter. Research is already underway to combine influenza and COVID vaccines into a single shot, and many locations already offer them as a package.
In the future, it’s possible that getting your COVID booster will be as routine as getting your annual flu shot, but only time will tell. Until then, so long as COVID remains a threat, you can rely on Medicare to cover your vaccination expenses.
If you’re looking for Medicare Advantage coverage, we can help. Call one of our friendly, licensed insurance agents today at (800) 950-0608, or enter your zip code into our free comparison tool to begin your search.
Austin is dedicated to breaking down complex topics, like Medicare, in a way that's easy to understand. He graduated with an M.A. from Florida Atlantic University in 2018.