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The updated2024-2025 COVID-19 booster is here, and public health officials are urging seniors and immunocompromised people to get protected ahead of respiratory virus season. But with the federal public health emergency officially over, it's understandable that Medicare recipients might be unsure about coverage.
The good news? Medicare does still cover the updated COVID-19 vaccine-including the latest versions from Pfizer-BioNTech, Moderna, and Novavax. But there's fine print that could catch some people off guard.
"It's covered-but not every provider follows the rules"
If you're on Original Medicare, you're fully covered as long as your provider accepts Medicare assignment. That means no copay, no coinsurance, and no deductible. It's the same story for Medicare Advantage, though you'll need to stick with in-network providers to avoid fees.
Where things get tricky is when providers tack on unnecessary charges. For example, they can't bill you for an office visit if the vaccine is the only service you receive. They also can't require extra services (like a physical or test) as a condition for giving the shot. If any of that happens, it's worth reporting to the HHS Office of Inspector General at oig.hhs.gov.
And yes-if you're homebound, Medicare will pay for the vaccine to be istered in your home, at no cost to you. Just make sure the provider is ed with Medicare and bring your red, white, and blue Medicare card.
Who needs the booster-and when
If you're 65+ or have a weakened immune system, the CDC recommends getting a multi-dose series of the updated vaccine. Your exact schedule depends on your previous COVID shots, so it's a good idea to talk to your provider or check CDC.gov for specifics.
Already had COVID recently? You may want to wait about three months before getting boosted, per the CDC's latest guidance.
What to do if you get Bbilled
If you were charged for a COVID-19 vaccine or an office visit when you shouldn't have been, take action. Call your provider, review your Medicare Summary Notice, and if something looks off, 1-800-MEDICARE or report it to the HHS OIG.
Vaccines remain one of the safest and most effective ways to protect yourself. And if you're on Medicare, they should also be one of the easiest-as long as you know what to expect.