Most Medicare vaccine coverage is provided by a Medicare prescription drug plan. However, some vaccines, like your seasonal flu shot, are covered by Medicare Part B.
Medicare beneficiaries generally rely on a Medicare prescription drug plan for Medicare vaccine coverage. However, all Medicare B enrollees are covered for certain vaccines, including a seasonal flu shot, a pneumococcal (pneumonia) vaccine and certain shots related to a doctor’s treatment of an injury or illness. For instance, Medicare Part B would cover a rabies shot administered by a physician after a dog bite.
Medicare Part B covers certain immunizations, including:
a seasonal flu shot
a seasonal H1N1 (swine flu) vaccine
a pneumococcal (pneumonia) vaccine
a different pneumococcal vaccine, if given at least a year after the first shot
Hepatitis B shots for high-risk beneficiaries.
Medicare Part B also covers certain shots when they’re directly related to a doctor’s treatment of an injury or illness. For instance, it would likely cover a tetanus shot if a Medicare B beneficiary stepped on a rusty nail.
Common vaccinations Medicare Part B does not cover include:
Shingles (Herpes Zoster) vaccine
tetanus, diphtheria, and pertussis (tdap) shot
Learn more about Medicare Part B.
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Medicare, the federal health insurance program primarily for elderly Americans, comes in four parts. Medicare Part A covers inpatient medical expenses; Medicare Part B covers outpatient medical expenses. Together, they comprise Original Medicare. Medicare Part C, also known as Medicare Advantage, is a private alternative to Original Medicare. Medicare Part D is prescription drug coverage for Original Medicare beneficiaries. (Our partner Via Benefits can help you compare Medicare plans in your area.)
To get a vaccination that isn’t covered by Medicare Part B, Medicare beneficiaries rely on their Medicare Part D plan or a Medicare Part C plan that comes with prescription drug coverage. These plans are known as Medicare Advantage Prescription Drug plans (MAPD).
Learn more about Medicare Part C Medicaid Advantage.
All Medicare prescription drug plans must cover commercially available vaccines when reasonable and medically necessary to prevent illness, according to the Centers for Medicare and Medicaid Services. However, specific rules for administration of and payment for the immunization varies across plans, as do the copay, coinsurance, premiums or deductibles.
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Vaccinations most commonly covered by Medicare prescription drug plans include:
Shingles (Herpes Zoster) vaccine
MMR (Measles, Mumps, & Rubella) vaccines
BCG (bacille Calmette-Guerin) vaccine for tuberculosis
Hepatitis A and Hepatitis B vaccines for low-risk beneficiaries
Certain self-administered insulin shots
Contact your Medicare prescription drug plan provider to find out what shots it covers, where you can get them and what you can expect to pay for the immunizations. You can also consult your plan’s formulary, or drug list, to see if a shot is covered. However, sometimes formularies are outdated and your plan may cover a new vaccine that is not yet listed. Medicare does not cover travel-related vaccines.
Yes, Medicare Part B covers one flu shot per flu season. They can also get a swine flu shot. Part B beneficiaries can get the vaccines for free so long as the health care provider accepts Medicare.
Yes, Medicare Part B covers one pneumococcal shot to prevent pneumonia and other pneumococcal infections. Part B also covers a second pneumococcal shot if it's different than the first and given at least one year after that initial immunization. Part B beneficiaries can get these vaccines for free so long as the health care provider accepts Medicare.
Medicare Part B will cover a tetanus shot if it is administered as treatment for illness or injury. Part B does not cover the Tdap vaccine, the booster shot for tetanus, diphtheria, and pertussis (whooping cough). In that case, you would need to have a Medicare prescription drug plan, which covers commercially available shots needed to prevent illness.
All Medicare prescription drug plans must cover the Shingles (Herpes Zoster) vaccine. However, plan providers can stipulate your receive the shot from a physician in lieu of pharmacist. The plan can also require a copay or coinsurance. You also might have to pay upfront and seek reimbursement after receiving the vaccination. Check with your plan provider to find out where you can get the shot and what is expected regarding payment. Medicare Part B does not cover the Shingles (Herpes Zoster) vaccine.
Low-income beneficiaries can receive federal assistance for out-of-pocket prescription drug coverage — and vaccinations by proxy — through the Extra Help program. The Extra Help program is only available to beneficiaries with a Medicare Part D prescription drug plan. It is not available to beneficiaries with a Medicare Advantage Prescription Drug plan.
Jeanine Skowronski is the head of content at Policygenius in New York City. Her work has been featured in The Wall Street Journal, American Banker Magazine, Newsweek, Business Insider, Yahoo Finance, MSN, CNBC and more. She has also appeared as an analyst on Good Morning America, The Willis Report, ABC World News with David Muir, NPR’s Marketplace and other local television and radio stations.