Flu Shot Questions and Answers for People With Medicare

Most people with Medicare should get a flu shot. If your regular doctor or provider doesn't have a flu shot available, you can go to any other licensed provider to get your shot. If the provider doesn't take Medicare, and you pay for the shot yourself, get a receipt, and Medicare will pay you back (about $18). Call 1-800-MEDICARE (1-800-633-4227) to find out where to send your receipt. TTY users should call 1-877-486-2048.

People in the following groups should get a flu shot this season:

People 50 or older
Anyone with a chronic condition such as heart disease, lung disease, diabetes, kidney disease, anemia, or other blood disorders
Nursing home residents
Pregnant women
Health care workers who provide direct patient care
Children ages 6-59 months
Children and adolescents on long-term aspirin therapy
People with certain muscle or nerve disorders that can lead to breathing or swallowing problems
People with a weakened immune system
Anyone who cares for or lives with children aged 0-59 months or persons at high risk flu complications

Where can I get a flu shot?

Contact your local health department or ask your regular doctor or provider about places that might be offering flu shots. You can call 1-800-MEDICARE (1-800-633-4227) to get the phone number for your state health department.

What can I do if my regular doctor or provider doesn't have flu shots available?

You can go to any licensed doctor or provider to get a flu shot. If you go to a doctor or provider who participates in Medicare, you will pay nothing for the shot. You can also go to a doctor or provider who doesn't bill Medicare. You will have to pay for the flu shot and then submit a receipt to Medicare to get all or part of your payment back.

If I get a flu shot from a doctor or provider who doesn't bill Medicare, what should I do?

If you get your flu shot from a doctor or provider who doesn't bill Medicare, you will have to send Medicare a special form and receipt. You can get a receipt from the doctor or provider who gives you the flu shot. Make sure the receipt has the following information on it: the doctor or provider's name, the address, service provided ("flu shot"), the date you got the flu shot, and the amount you paid. To get this form and to find out where to send it, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. (You can also click here to get a copy of this form.)

How much will Medicare pay?

Medicare will pay about $18 for your flu shot if you go to a doctor or provider who doesn't participate in Medicare. This amount varies by state and could be less than a doctor or provider charges you.

I think my doctor or provider charged too much for my flu shot. What should I do?

If you think your doctor or provider charged an unfair amount for your flu shot, call the Inspector General's hotline at 1-800-HHS-TIPS (1-800-447-8477) and make a complaint.

If I can't get the flu shot, can I take FluMist instead?

Most people with Medicare shouldn't take FluMist because it is approved only for healthy people ages 5-49. The only people with Medicare who may take FluMist are healthy disabled persons age 49 or under. You should check with your doctor or other health care provider to see if FluMist is available and if you can take it.

Will getting a flu shot help keep me from getting sick?

If you get a flu shot there is a chance that you may still get the flu, but your symptoms will be less severe. You need a flu shot every year because flu viruses are always changing. The shot is updated each year for the most current flu viruses.

What other steps can I take to prevent the flu?

There are other good health habits that can help prevent the flu. To help prevent the flu

avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
stay home when you are sick, if possible. You will help prevent others from catching your illness.
cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
wash your hands often to help protect yourself from germs.
avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.