As we age, we grow more vulnerable to chronic and seasonal illnesses. And many times these illnesses can hit hard and fast, sometimes making it difficult to recover. But taking preventative measures against illnesses, like getting vaccines, is a safe course of action.
To help accomplish this, Medicare beneficiaries have access to comprehensive benefits for routine vaccinations. In this guide to Medicare vaccine coverage, we’ll review how vaccines are covered by Original Medicare and the various private Medicare insurance plans on the market.
It’s much easier to avoid getting sick with some illnesses than it is to treat, recover or survive them. This is especially true for those ages 65 and up: Illnesses such as the flu, pneumonia, and COVID-19 can take a heavy toll on this population.
And since most of these illnesses are seasonal by nature, they’re perfect candidates for vaccines. In fact, the CDC recommends that adults ages 65 and over have annual vaccination against the flu.
Studies have shown that seniors who are vaccinated are more likely to avoid seasonal illnesses and have fewer severe symptoms, including a decreased chance of:
However, there are non-seasonal vaccinations for adults over age 65. These may include:
Quick Medicare Tip: Be sure to check with your doctor for advice on which vaccines to get and how frequently you should receive them. This is especially important because of the potential for interactions with existing health conditions.
Medicare vaccination coverage depends on how the specific vaccines are categorized. In other words, vaccines can be covered by Medicare Part B. But in other cases, vaccines are covered by Medicare Part D drug plans.
Medicare Part B covers outpatient medical care, broken down into two groups of services:
You’ll use Part B for routine healthcare like doctor’s visits and lab work. Unlike Part A of Original Medicare, you’ll probably have to pay a monthly premium to have Part B coverage.
Medicare Part B covers vaccinations under the preventive services category. And many recommended elderly immunizations are included in Medicare Part B vaccine coverage. The following vaccines are among the most important.
Medicare Part B covers influenza vaccinations. Medicare will cover one flu shot per person, per flu season. And you will pay nothing as long as you receive your flu shot from a doctor or other qualified health care worker who accepts Medicare “assignment.” This means that they agree to accept Medicare’s payment as payment in full.
Most doctors and health care practitioners take Medicare Assignment.
Hepatitis B Shots
Medicare Part B vaccine coverage for the Hepatitis B vaccine is a little more complicated. Part B will cover it, but only if you’re at moderate or high risk.
You’re considered to have medium or high risk if any of these apply to you:
If you meet these criteria and receive the shot from a practitioner who accepts Medicare assignment, you’ll pay nothing. The Hepatitis B vaccine may be given as a series of two or three injections, depending on which vaccine is used.
Medicare Part B will cover a total of two pneumococcal shots for seniors.
You can get the first shot at any time, and Part B will cover the second shot as long as you receive it at least one year after your first injection. Like other instances of Medicare vaccine coverage, you’ll pay nothing out of pocket if you get the pneumococcal shots from a qualified practitioner who takes Medicare assignment.
As the newest and most urgently needed vaccine on the block, Medicare Part B will cover the COVID-19 vaccine. We’ll review some of the specifics of COVID-19 Medicare Part B vaccination coverage shortly. For now, COVID-19 vaccine coverage through Medicare Part B is all available for no out-of-pocket cost.
Quick Medicare Tip: Need more help understanding Medicare Part B? Visit our Guide to Medicare Part B to learn how Medicare Part B coverage works.
Medicare Part D is the prescription drug program for Medicare beneficiaries. Drug coverage is not available as part of the Original Medicare Fee-for-Service program. Instead, it’s offered by private insurance companies.
Medicare Part D drug coverage is available as 2 types of plans:
Whether you get prescription drug coverage from a standalone plan or a Medicare Advantage plan, the drug coverage works the same. In both cases, your insurance company helps pay part of the cost of your medications. Unlike Medicare Part B vaccine coverage, you’ll generally have to pay some share of the cost for Medicare Part D vaccination coverage.
The formal list of drugs and vaccines covered is known as a Medicare Part D formulary. The formulary is an exclusive list. Two things to know:
That said, it’s important to make sure that you only use medications or vaccines that are on your plan’s formulary.
With Part D drug coverage, you’ll usually pay a copayment or coinsurance amount for each drug or vaccination you receive. But this amount can change during the course of the calendar year as you move through the four coverage stages of Medicare Part D. Part D drug plans cover vaccines that are not covered by Medicare Part B. Generally speaking, these vaccines are considered to be less necessary than the vaccines covered by Part B.
And since Medicare Part D vaccine coverage is provided by a private insurance plan, you don’t have to worry about whether your practitioner accepts Medicare assignment. As long as they accept your Part D plan, you’ll only pay the required copayment or coinsurance.
Zoster (Shingles) Vaccine
The shingles vaccine is covered by Medicare Part D plans. The CDC recommends that people over age 65 receive two doses of this vaccine.
Private Part D drug plans cover the Measles, Mumps, and Rubella vaccine in one or two doses if you were born after 1957.
The tetanus, diphtheria, and pertussis vaccine is eligible to be covered by Medicare Part D plans. The CDC recommends that you receive a new shot every ten years. A more frequent dose may be required in response to some wound care situations.
Again, your vaccine costs will vary based on your individual plan formulary as part of Medicare Part D vaccine coverage. To find out how much you’ll pay, you’ll need to contact your Part D plan.
If you have trouble affording medications including Part D covered vaccinations, you may be able to get assistance through the Extra Help program.
Extra Help is available to people who meet certain income and asset requirements. If you qualify, you’ll pay less for your medications, and you may even get help paying for your Medicare Part D premium. You will have to recertify for Extra Help each year, but the savings are worth the effort.
Quick Medicare Tip: Visit our Guide to Medicare Part D to read more about how Part D coverage works.
As we covered earlier, adults ages 65 and up are more vulnerable to coronavirus than other age demographics. And COVID-19 has definitely taken its toll on this age group.
That’s why it’s especially key that Medicare beneficiaries take advantage of their Medicare benefits, including Medicare coverage for COVID-19. Under a provision of the 2020 CARES Act, any FDA-approved coronavirus vaccine will be covered by Medicare Part B. This includes both two-shot vaccines and single dose COVID-19 vaccines.
As long as the coronavirus vaccines are FDA-approved, Medicare will cover the costs.
Also, since Medicare Advantage is required to have the same coverage as Original Medicare, Medicare Advantage plans also cover the coronavirus vaccine.
Other key things to know about Medicare coverage for coronavirus includes:
As a general rule, Medicare does not cover vaccinations for international travel. However, some Part D drug plans may offer coverage for vaccinations necessary for travelling outside the U.S. Be sure to contact your Medicare Part D plan to see if this is the case. Otherwise, you’ll need to pay out of pocket for your travel immunizations.
Vaccines aren’t just for kids - they’re an important way for all ages to keep healthy and prevent illnesses.
And Medicare vaccine coverage gives those ages 65 and up the support needed to get access to crucial vaccines. After all, preventing infection is much easier than treating certain illnesses, especially those that affect the respiratory system like COVID-19, flu, and pneumonia.
Through Medicare Part B of Original Medicare and Medicare Part D drug plans, you can be sure that necessary vaccines will be covered at the optimal doses and frequency.
But just because a vaccine is recommended for most people and covered by Medicare doesn’t mean that you should run out and get it. Some vaccines may not be suited to you based on your individual health status and history. For this reason, it’s critical that you speak with your doctor about the vaccines you should and shouldn’t receive.
You can also learn more about Medicare coverage for vaccines on the benefits provided by your Medicare insurance plan. Just remember: Part D plans change their formularies every year, so the costs of Medicare Part D vaccines may change. Always review your coverage during the Medicare Open Enrollment Period, and consider switching to a plan that better suits your needs if necessary.
If you’d like to get help finding a Medicare plan, call 800-620-4519 to speak with one of our licensed insurance agents, or click to try our Medicare plan comparison tool to find Medicare Advantage or Prescription Drug Plans near you.
The above information does not constitute medical advice. Always consult with a medical professional regarding your health needs. If you are experiencing a health emergency, contact your local emergency health services immediately or visit the nearest emergency room or urgent care.
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