Learning Center > What Vaccines Are Covered By Medicare: A Guide To Shots And Medicare

What Vaccines Are Covered By Medicare: A Guide To Shots And Medicare

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.

The Importance Of Vaccines For Adults Over 65

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:

  • Doctor’s visits
  • Hospitalizations
  • Death

However, there are non-seasonal vaccinations for adults over age 65. These may include:

  • Varicella / Shingles
  • Tdap
  • Pneumococcal
  • Hepatitis A and B

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.

What Vaccines Does Medicare Cover?

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 Vaccine Coverage

Medicare Part B covers outpatient medical care, broken down into two groups of services:

  • Medically necessary services, and
  • Preventative 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.

Flu Vaccines

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:

  • You have hemophilia
  • You have End Stage Renal Disease (ESRD)
  • You have diabetes
  • You live with someone who has Hepatitis B
  • You’re a healthcare worker and frequently exposed to bodily fluids

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.

Pneumococcal Shots

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.

COVID-19 Vaccine

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 Vaccine Coverage

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:

  • Standalone Prescription Drug Plans (PDP), and
  • Medicare Advantage Prescription Drug (MAPD) 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:

  • If a drug or vaccine isn’t on the formulary, then the plan doesn’t cover it.
  • If you receive medications of vaccines that aren’t on your plan’s formulary, then the plan won’t cover it and you’ll pay full price.

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.

MMR Vaccine

Private Part D drug plans cover the Measles, Mumps, and Rubella vaccine in one or two doses if you were born after 1957.

Tdap Vaccine

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.

How Does Medicare Cover The Coronavirus Vaccine?

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:

  • Medicare covers COVID-19 testing.
  • Medicare covers COVID-19 antibody tests.
  • Medicare covers all medically necessary hospitalizations, including hospital stays for COVID-19 treatment and quarantine requirements.
  • Medicare Advantage plans can’t charge deductibles, copayments and coinsurance for tests that detect or diagnose COVID-19.
  • Medicare Advantage plans may offer additional benefits like telemedicine to keep you out of the waiting room and get non-emergency care at home.

How Does Medicare Cover Travel Vaccinations?

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.

Conclusion: Medicare and Vaccines

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.

Get a Free Quote

Get a Free Quote

What you should read next

If you’re approaching your 65th birthday or caring for an older relative, you may be wondering how to apply for Medicare. Do you have to apply specifically, or is coverage provided automatically? What form(s) do you need? The answer depends on your unique situation and medical needs. In this article, we’ll help you understand how to apply for Medicare in a variety of situations. How To Apply For Medicare Part A and B? Medicare Part A is hospital insurance, while Medicare Part B is medical insurance. For most Americans with sufficient work history, there’s no monthly premium associated with Part A coverage. There is a monthly cost for Medicare Part B. Curious how to apply for Medicare Part A? You may not need to! You’ll receive Medicare Part A and B automatically without applying if you’re receiving Social Security or Railroad Retirement Benefits (RRB) for at least four months before you turn 65. If you’re not receiving Social Security benefits before you turn 65, you’ll have to enroll with Social Security to get the coverage you need. If you’re still working and have a group health insurance plan when you become Medicare-eligible, you can choose to delay enrollment in Medicare Part B without later paying a penalty when you enroll. When your group health insurance plan ends, you can apply online or by using the Part B enrollment form. If you have qualifying disabilities and you’re under 65, you’ll receive Part A and Part B automatically after you’ve received Social Security disability benefits for 24 months. If you have ALS (Lou Gehrig’s Disease), you’ll automatically get Medicare Parts A and B the month your disability benefits begin. Finally, if you have End-Stage Renal Disease, Medicare benefits are optional. If you want them, you will need to sign up by contacting Social Security. How To Apply For Medicare Part C & D Medicare Part C, also known as Medicare Advantage, is an all-in-one replacement for Original Medicare and includes additional benefits. For instance, most Medicare Advantage plans include prescription drug coverage, and some include vision, dental, and other benefits. You can purchase Medicare Advantage plans directly from private insurance companies. The plans vary in terms of price, benefits, and medical network. That’s why it’s important to get multiple quotes and compare your options before you make a decision. Medicare Part Dis an optional add-on that you can have in addition to Parts A and B. Part D, also known as a Medicare drug plan, provides prescription drug coverage and costs an additional monthly premium. How to Apply for Medicare Part D You can apply for Medicare drug plans using the Medicare Plan Finder tool or by calling the provider directly. Applying For Medicare FAQs As you review your Medicare options, you may find that you have a few questions. Here are some of the most common concerns we hear. What Documents Do I Need To Apply For Medicare? If you’re automatically enrolled in Medicare Part A and B, you won’t need any additional documentation. However, if you enroll yourself, you will need to provide your date and place of birth and information on any current health insurance, whether that’s Medicaid, private coverage, or group coverage from your employer. How Do I Sign Up For Medicare Online? Signing up for Medicare online is the easiest option if you aren’t automatically enrolled. Find and compare Medicare plans online. Learn More About How to Apply for Medicare With its various parts and enrollment dates, navigating Medicare can be a challenge. We’re here to make it easier for you. Contact us to speak to a licensed insurance agent who can answer all of your Medicare application questions.
Read More »

Medicare was originally designed for individuals who had retired from the workforce. As a result, the standard was set that you qualify for Medicare when you’re 65 years old. However, there are now additional ways to qualify for Medicare. Younger people with qualifying disabilities can also be eligible, along with individuals with end-stage renal disease. If you meet certain qualifications, you can get Medicare Part A for free, but Medicare Part B comes with a monthly premium. It’s important to understand who is eligible for Medicare Part A and Part B and who is not eligible for Medicare so you get the benefits you understand your medical benefits and costs. Medicare Eligibility Requirements There are a variety of requirements to be eligible for Medicare, especially if you want Part A with no monthly premium. Below are some of the more specific details on Medicare eligibility requirements. To qualify for Medicare you need to: Be a U.S. citizen or permanent legal resident who has been in the U.S. for at least five years Be 65 or older You can qualify for Medicare if you’re under 65 but have a qualifying disability or end-stage renal disease Who Qualifies for Premium-Free Medicare Part A? You can get Medicare Part A without a premium if: You are 65 or older and you or a spouse worked and paid Medicare taxes for at least 10 years You receive benefits from Social Security or the Railroad Retirement Board You or your spouse had government employment that was Medicare-covered Who Can Apply For Medicare Part A and Part B? Anyone who meets the eligibility requirements can apply for Medicare coverage. Your initial enrollment period begins three months before your 65th birthday and lasts seven months. If you sign up during the first three months of your enrollment period, your Medicare coverage will go into effect the first day of the month you turn 65. If you qualify for premium-free Medicare Part A and you are receiving Social Security benefits when you become eligible for Medicare, your Part A coverage will begin automatically when you turn 65. . If you’re not receiving benefits, you can still get Medicare Part A on time by enrolling online or contacting Medicare directly. While Part A may be automatic for some, all individuals must apply to enroll in Part B. You can sign up for Part B during your initial enrollment period that occurs around your entitlement to Part A, and then generally only between January 1 and March 31 of each year (unless you have delayed because you continue to work). . If you don’t apply for Medicare Part B when you’re eligible, you’ll most likely have to pay a late enrollment penalty. If you have to pay for Medicare Part A, it follows the same rules as Medicare Part B. You can only enroll at specific times, and you have to sign up. Who can Apply for Medicare Online? Any qualifying individual can apply for Medicare online, however, you can only sign up during the initial enrollment period and then between January 1 and March 31 of each year. Medicare Eligibility FAQs Here are a few common questions we hear about Medicare eligibility: Can I Get Medicare at 62? Some people begin to claim retirement benefits from social security at age 62 and might wonder if they can also get Medicare benefits at that time. Generally, the answer is no. You can only get Medicare before age 65 if you have been on Social Security disability for at least two years, have ALS (Lou Gherig’s disease), or suffer from end-stage renal disease. Can You Get Medicare If You’ve Never Worked? If you haven’t worked, you can still qualify for Medicare, but you may have to pay a monthly premium for both Medicare Part A and Part B. You may still be able to get Medicare Part A premium-free if your spouse worked, or if you have specific disabilities or medical conditions. Who Can Get Premium-Free Medicare Part A? You can qualify for premium-free Medicare Part A if you qualify for Original Medicare and have the appropriate work history as described above (i.e. paid Medicare taxes for 10 years). Generally, you have to pay a premium for Medicare Part B, but there are options for those with limited income and limited assets. The Medicare Savings Program (MSP) can help pay your Medicare Part A and B premiums if you qualify. Learn More About Medicare Eligibility Requirements If you’re curious about your Medicare eligibility and want to talk to a licensed insurance agent, we’re here to help. Simply give us a call at 1-866-955-0898 (TTY 711) or visit our website to review your options today!
Read More »

Medicare is a health insurance program provided by the federal government. Medicare is provided for individuals who are 65 and older, as well as younger people with disabilities or end-stage renal disease. Medicare includes several parts, each of which provides coverage for specific medical needs. Original Medicare includes Part A (hospital coverage), Part B (medical coverage), and Part D (prescription medication coverage). Medicare Part C is known as Medicare Advantage. Who Qualifies for Medicare? As we mentioned above, an individual qualifies for Medicare if he or she is 65 or older. Younger individuals can qualify for Medicare if they are permanently disabled or diagnosed with end-stage renal disease. What Is The Purpose Of Medicare? Medicare is available to make health coverage accessible to older Americans age 65 and over, including those who are traditionally retired and no longer have access to employer-based health insurance. Medicare also provides coverage to those under 65 with certain disabilities to cover their health needs and associated expenses. These Americans often cannot work and don’t have access to employer coverage or other health insurance. Types of Medicare Medicare is divided into several parts, labeled from A to D: Medicare Part A is known as hospital insurance. It offers coverage for inpatient hospital care, lab tests, and surgery, as well as home health care and skilled nursing facilities. These services must be deemed medically necessary to be covered by Medicare. You may have to pay a deductible or coinsurance Medicare Part B is used for medical visits to a doctor. Medicare covers medically necessary services and preventive services. Each Medicare participant pays a monthly premium for Medicare Part B and there may also be deductibles and coinsurance that apply, depending on the care you receive Medicare Part C is known as Medicare Advantage. This isn’t part of Original Medicare but instead is an all-in-one replacement plan. Medicare Advantage plans include hospital coverage and doctor’s visits, along with prescription drug coverage. Many also offer additional benefits Original Medicare doesn’t cover, such as vision and dental care. However, you will often need to use medical professionals within the provider’s network. You’ll pay different copayments and deductibles with Medicare Advantage than with Original Medicare, which may allow you to save money. You may also have an additional monthly premium Medicare Part D is prescription drug coverage. It helps you pay for both brand-name and generic drugs, depending on your needs. The drug plans for Medicare are offered by insurance companies and other approved private companies. If you choose Medicare Part D, you will have a separate Part D premium each month Medicare FAQ In addition to the different types of Medicare, qualified individuals, caregivers, and loved ones often have questions about Medicare coverage. Here are some additional Medicare FAQ and answers. What Does Medicare Cover? Medicare covers a wide variety of healthcare services. The specific coverage depends on the Medicare policy you choose. Services covered by Medicare include: Ambulance services Anesthesia Artificial eyes & limbs Bariatric surgery Blood processing & handling Cardiac rehabilitation programs Cardiovascular disease screenings Cervical & vaginal cancer screenings Chemotherapy Depression screenings Diabetes prevention programs Diagnostic tests (laboratory and non-lab) Eye exams (routine) Eyeglasses & contact lenses Flu shots Foot care Hearing aids Hepatitis B and HIV screenings Inpatient hospital care Kidney transplants Lung cancer screenings Mammograms Mental health care (inpatient and outpatient) Occupational therapy Opioid use disorder treatment services Organ transplants Pain management Prescription drugs (outpatient) Preventive & screening services Radiation therapy Sexually transmitted infections screenings & counseling Sleep studies Surgery Urgently needed care X-rays Yearly "wellness" visits Do I Need Medicare if I Already Have Health Insurance? Whether or not you need Medicare if you already have health insurance depends on your individual medical needs. You may need Medicare even if you already have other health insurance if your current plan doesn’t meet the minimum coverage requirements. Most plans offered by employers meet these standards. So if you have insurance through your job, you probably don't need Medicare. However, by staying on an employer plan, you can delay enrolling in Part B without a penalty and avoid paying Part B premiums. An important note: When you have Medicare plus additional insurance policies, each provider becomes a "payer." The policy that pays for your specific medical services first depends on the coordination of benefits rules for your plans. In other words, the primary payer will pay what it owes on your medical bills first, then the provider will send the remaining amount to the secondary payer to pay the rest. What is the Difference Between Medicare and Medicaid? Medicare is a federal health insurance program for older Americans and those with disabilities regardless of income. Medicaid is a state-based health insurance program for lower-income Americans that need help paying for medical care. To learn more about costs, eligibility, and coverage, visit this guide to Medicare vs. Medicaid. Who Do You Call for Medicare Questions? If you have additional questions about Medicare and what it covers, you can call 1-866-955-0898 (TTY 711) to speak with one of our licensed insurance agents. Agents are available Monday - Friday from 8am - 9pm and Saturday - Sunday 10am - 5pm ET. Where Can I Get Free Medicare Advice? For information on Medicare coverage, open enrollment, the different types of Medicare, and more, visit our Medicare learning center. For specific Medicare questions, contact us to speak with a licensed insurance agent. Learn More About Medicare Medicare is a valuable way to cover your healthcare costs if you are older or disabled. To compare your options and find the right Medicare plan in your area, visit our Medicare plans page today!
Read More »

Healthinsurance.com LLC is a commercial site designed for the solicitation of insurance from selected health insurance carriers. It is not an insurer, an insurance agency, or a medical provider. You may obtain a complete list of available Medicare plans by contacting 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

This site is not maintained by or affiliated with the federal government’s Health Insurance Marketplace website or any state government health insurance marketplace.