Blog

Which Vaccines Does Medicare Cover

Vaccinations are an important part of preventive healthcare, especially for older adults who may be at higher risk of serious illness. Fortunately, Medicare provides coverage for many common vaccines, but which vaccines does Medicare cover? Additionally, knowing which part of Medicare covers what can help beneficiaries avoid surprise costs.

Vaccines Covered by Medicare Part B

Medicare Part B covers certain vaccines that are considered medically necessary for disease prevention. These include:

• Flu shot (Influenza vaccine): Covered once per flu season, and sometimes more if medically necessary.
• Pneumococcal vaccine: Helps prevent pneumonia and other infections. Medicare covers two different pneumococcal shots at no cost when given at least one year apart.
• Hepatitis B vaccine: Covered for beneficiaries at medium or high risk (such as those with diabetes, liver disease, or certain occupational exposures).
• Vaccines needed due to injury or exposure: For example, if you’re exposed to rabies or step on a rusty nail and need a tetanus shot, Medicare Part B covers it.

There’s no deductible or copayment for these vaccines if you receive them from a provider who accepts Medicare assignment.

Vaccines Covered by Medicare Part D

Medicare Part D (prescription drug coverage) handles most other commercially available vaccines that are not covered by Part B. This includes:

• Shingles (Herpes Zoster) vaccine
• Tetanus, Diphtheria, and Pertussis (Tdap) vaccine when not related to an injury
• RSV (Respiratory Syncytial Virus) vaccine for older adults
• Travel vaccines, such as those for hepatitis A or typhoid, depending on your plan

Part D plans must cover all vaccines recommended by the Centers for Disease Control and Prevention (CDC) that aren’t already covered by Part B. Since 2023, beneficiaries pay no out-of-pocket costs for these recommended vaccines under Part D.

Watch a YouTube video on the Medicare Prescription Payment Program

Why Staying Up to Date Matters

Getting the right vaccines can help prevent hospitalizations and serious illness. With Medicare’s expanded coverage, beneficiaries can stay current on vaccinations at little to no cost. It’s always best to check with your provider or Part D plan to confirm coverage before receiving any vaccine

Medicare agents; if you are ready to join the team at Crowe – click here.

Medicare makes it easier than ever to stay protected. Part B covers flu, pneumonia, Hepatitis B (for those at risk), and vaccines needed due to injury, while Part D covers all other recommended vaccines; often at no cost.

Click here to stay up-to-date on agent events and information

Vaccines covered by Medicare

Medicare prescription drug plans cover wide variety of prescription drugs, this includes several vaccines covered by Medicare.  Medicare covers vaccines in more than one way; either by Part D  or by Part B (medical coverage) or Part C MA/MAPD plans that may provide coverage for all the parts of Medicare.  It all depends on the type of vaccination and what facility the patient receives it at. As of January 2023, all vaccines covered by Medicare should be free to beneficiaries. This means they should not have any cost-sharing such as; co-pays, co-insurance or deductibles.

Find out about Medicare Part D enrollment periods

Part B covers vaccine coverage

In many cases, if the vaccination is part of a treatment for an illness or injury, it is usually covered by Part B.  In other words, if a beneficiary gets a puncture wound, they may need a tetanus shot. When this is the case, the vaccination falls under Medicare Part B coverage (Part C, if they have an MA/MAPD plan).  If the beneficiary opts to receive a tetanus booster shot, that charge falls under their Part D plan.

Watch a quick YouTube video on enrollment periods including Part B late enrollment

Here are some common vaccines that Part B covers:

*Flu

*Covid 19

*Pneumonia

*Hepatitis B – in cases where the individual is at high to intermediate risk.

*Some necessary vaccines needed to treat an injury, illness or exposure to a disease.

Part B covers some drugs

In some instances, Part B covers drugs beneficiaries do not normally give themselves.  In other words drugs that you receive either in a doctor’s office or in an outpatient hospital setting.

A few of the drugs covered by Part B

Part D vaccine coverage

Part D Vaccines are provided in an effort to prevent illness as opposed to treating one.  Medicare Part D plans cover commercial vaccines if they are reasonably necessary.

Some vaccines covered by Part D

1. Shingles vaccines
2. Tdap (tetanus-diphtheria-whooping cough) vaccines
3. In cases that a PDP plan’s formulary does not list a vaccine, it must provide coverage if a physician prescribes it as a prevention measure.

Learn about the Medicare Part D drug cap

As of January 2023, patients with Medicare Part D plans or MAPD plans pay no out-of-pocket costs for adult vaccines.  This is part of the Inflation Reduction Act of 2022.  If the patient is charged a vaccine administration fee at the time of service, they can submit this amount to their Part D plan for full reimbursement.

To view more images by this artist, click here