High-Dose Flu Vaccine Covered by Medicare

Written by on November 30, 2012 in Insight - No comments

This is a tricky time of year for physicians as we continue to encourage our patients to get vaccinated against influenza and also begin to think about ordering our vaccine supply for the next influenza season.

Importantly, it is not too late to vaccinate.  Once administered, the influenza vaccine takes about two weeks to build full immunity AND typically influenza does not peak until February – so there is still plenty of time to protect our patients against influenza this flu season – especially our most vulnerable elderly patients.

Two years ago, the FDA approved the higher dose influenza vaccine for adults age 65 and older.  It was designed to address age-related decline in immune response among those 65 and older by increasing the amount of antigen (x4) as the standard vaccine.

This high dose influenza vaccine is important because according to the Centers for Medicare and Medicaid Services (CMS), pneumonia and influenza are the fifth leading cause of deaths in older adults. Medicare Part B pays for one influenza vaccine each year with no copayment or deductible applied. Medicare generally pays for one pneumonia vaccination for all Medicare beneficiaries per lifetime.

Despite full coverage for both the pneumonia and the high-dose influenza vaccine, rates of immunization in the senior population remain suboptimal, particularly in minority populations. This could be due in part to lack of education about Medicare benefits, so we must let patients know: first, these vaccines are important and, second, they are covered by Medicare.

It is also important to remind elderly patients to get their flu vaccine as part of a scheduled visit.  Providers are unable to bill Medicare for an office visit when the only reason for the visit is a vaccine. If the office visit is for a medical reason covered under Medicare, the vaccine given in conjunction with that visit will be covered. Additionally, some Medicare Advantage plans limit the number of contracted providers for their Medicare members, which may eliminate some of the more convenient vaccine locations for seniors to receive their flu vaccine — such as supermarket pharmacies. Knowing all this, we can take the necessary steps to help elderly patients receive their annual flu vaccine, while still complying with Medicare policies.

To find out more about this issue, visit: http://www.cms.gov/AdultImmunizations/02_Providerresources.asp.

by Merle Turner, D.O.

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