Can You Get a Flu Shot or Other Vaccines on Hospice?

Yes, someone on hospice can still get a flu shot and other vaccines, and for the flu and pneumonia shots they usually pay nothing. Vaccines are not part of the Medicare hospice benefit, so they are paid separately by Medicare, not out of the hospice's budget. Choosing hospice does not take away your loved one's right to them, and the hospice itself, a doctor, or a pharmacy can give them.

Families raise this question every fall, especially when a frail parent lives with others or receives a steady stream of visitors. Here is how vaccines work once someone has elected hospice.

Why vaccines sit outside the hospice benefit

When a person elects hospice, Medicare's hospice benefit takes over the care related to the terminal illness. Vaccines are treated differently. CMS instructions to Medicare contractors state that vaccines and their administration are not part of the Medicare hospice benefit, so a hospice that gives one bills it on a separate claim that contains only the vaccine and the shot. CMS directs that these vaccine claims are paid from the Part B trust fund, are not subject to deductible and coinsurance, and are left out of the hospice's payment cap.

CMS has also clarified that any provider may furnish vaccines to hospice patients, not only the hospice. So your loved one can get a shot from the hospice nurse if the hospice offers it, from their regular doctor, or at a pharmacy.

Which vaccines are covered, and by which part of Medicare

Coverage details come from Medicare.gov's vaccine pages; check them each season, because the recommended shots change. CMS's hospice billing instructions specifically name the influenza, pneumococcal, hepatitis B, and COVID-19 vaccines.

Should someone on hospice get a vaccine?

That is a personal and medical decision, not a coverage question. Some things families weigh with the hospice nurse or physician:

• How the person is doing. Someone who is still up, eating, and seeing visitors may want protection from flu season. Someone in the last days of life may be past the point where a shot is worth the needle stick, and the team may suggest skipping it.
• Who is around them. Grandchildren, caregivers, and visitors come and go, and the person may be frail. Ask the team how much that matters for your loved one.
• What the person wants. Many people want to keep their usual routine; others would rather avoid any needle stick. Either choice can be honored.

The hospice can talk this through with you as part of the plan of care conversation.

The misconception to correct

Some families assume hospice means "no more shots, no more preventive care," or that the hospice will refuse a flu shot because it costs the hospice money. Neither is true. Vaccines are paid outside the hospice's daily rate, so the hospice is not paying for them out of its own budget, and Medicare lets any provider give them. Hospice also does not cut off care for conditions unrelated to the terminal illness; Medicare.gov says Original Medicare still pays for covered benefits for health problems that are not part of the terminal illness. For how medicines are handled, see whether hospice stops your other medications.

How to get the shot

1. Ask the hospice first. Some hospices give flu shots to their patients during nurse visits. Ask whether yours does.
2. If not, use your usual provider. A pharmacy or the person's own doctor can give it. Bring the Medicare card, and, for the shingles shot, the Part D plan card.
3. Tell the hospice nurse afterward. The team should know about any new medication or vaccine so they can watch for side effects such as a sore arm or low fever and keep the record complete.

Frequently asked questions

Will a flu shot interfere with hospice care?

No. Getting a vaccine does not change hospice eligibility or require leaving hospice. It is simply a covered Medicare service that sits outside the hospice benefit.

Can my loved one get a COVID-19 vaccine on hospice?

Yes. Medicare.gov says Part B covers the updated COVID-19 vaccine and that you pay nothing if the provider accepts assignment. Electing hospice does not remove Part B coverage for services outside the hospice benefit, so ask the hospice, the person's doctor, or a pharmacy.

Do we pay anything for a flu or pneumonia shot on hospice?

Usually not. Medicare.gov says you pay nothing for these vaccines if the provider accepts assignment, and CMS instructions say hospice vaccine claims are not subject to deductible and coinsurance.

Can the hospice nurse give the shot at home?

Some hospices do. CMS rules allow a hospice to provide vaccines to patients who request them and bill Medicare separately. Ask whether your hospice offers this during routine nurse visits.

Questions to ask the hospice

• Do you give flu or other vaccines to your patients, and when?
• Do you recommend vaccines for my loved one at this stage?
• Who should we tell if a pharmacy or doctor gives the shot?

What to do next

Make vaccines one of the topics on your list for the next nurse visit, especially before flu season. If you are still choosing care, ask each hospice how it handles vaccines and compare hospices near you by city.