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What Vaccines Are Covered by Medicare: A Guide to Medicare and Immunizations

March 11, 2021

What Vaccines Are Covered by Medicare: A Guide to Medicare and Immunizations

As we age, we grow more vulnerable to chronic and seasonal illnesses. Many times, these illnesses can hit hard and fast, sometimes making it difficult to recover. But taking preventative measures like getting vaccines can protect you. And thankfully, Medicare beneficiaries have access to comprehensive benefits for routine vaccinations. 

In this guide to Medicare vaccine coverage, we’ll review which vaccines and immunizations 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.

Does Medicare Coverage My Flu Shot?

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.

Will Medicare Pay for 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.

Does Medicare Pay for 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.

Does Medicare Pay for 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.

Is Shingles Vaccine (Zoster) Covered by Medicare?

The shingles vaccine is covered by Medicare Part D plans. The CDC recommends that people over age 65 receive two doses of this vaccine.

Is the Shingrix Vaccine Covered by Medicare?

Shingrix, another shingles vaccine, is covered through standalone Medicare Part D plans.

Will Medicare Cover 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.

Does Medicare Cover 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.

Does Medicare Cover Tetanus Shots?

Medicare will cover a tetanus shot, however, the specific part of Medicare that provides the coverage depends on the reason you need the shot.

  • Medicare Part B covers tetanus shots following an injury or illness
  • Medicare Part D covers the regular tetanus booster
  • Medicare Part C (Medicare Advantage) covers both scenarios

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.

Does Medicare Cover Travel Vaccines?

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 traveling 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: Does Medicare Cover Immunizations and Vaccines?

Vaccines aren’t just for kids - they’re an important way for all ages to keep healthy and prevent illnesses. Medicare vaccine coverage gives Medicare-eligible consumers access to crucial vaccines. After all, preventing infection is much easier than treating certain illnesses.

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. 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 learn about your Medicare benefits, including what vaccines your Medicare plan covers, by reading your plan documents. 

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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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