Staying up to date with vaccinations is important for maintaining good health and preventing the spread of contagious diseases. For those on Medicare, knowing how Medicare covers vaccines can ensure you stay healthy and limit your out of pocket expenses. This guide explores the ins and outs of Medicare coverage for vaccines so you know how to seek care.
Continue reading to learn more about the following covered vaccines:
Medicare Part B Covered Vaccines
Medicare covers vaccines under Part B or Part D depending on the vaccine. First we will explore the vaccines covered under Part B. The vaccines listed below fall under Part B coverage and do not come with an associated cost share. However, some vaccines require elevated risk factors for coverage
Annual Flu Vaccine:
People who are 65 and older are at high risk of having serious health complications from the flu. The flu shot protects you from getting the flu and keeps you from spreading it to others. Medicare provides coverage for the seasonal flu shot one time each flu season.
Covid-19 Vaccine:
Medicare covers the updated COVID-19 vaccine, and recommended boosters. You won’t pay a deductible or copayment, and your provider can’t charge you an administration fee to give you the shot. When the federal government stops buying and distributing the vaccine, you’ll still pay nothing for the vaccine if your doctor or other health care provider accepts assignment.
Hepatitis Vaccine:
Medicare Part B will cover the Hepatitis Vaccine if you are at medium to high risk for Hepatitis B, which can increase if you have hemophilia, End-Stage Renal Disease, diabetes, or live with someone with Hepatitis. You will pay nothing for Hepatitis B shots if you go to a doctor that accepts Medicare.
Medicare Part D Covered Vaccines
Many Part D vaccines used to have a cost-sharing prior to 2023. Good news! Medicare changed the rules in 2023 to cover any ACIP-recommended vaccines. These vaccines are covered without cost-sharing and you do not have to meet your deductible. Part D plans must include most commercially available vaccines on their formularies.
ACIP-recommended drugs include:
Shingles Vaccine:
This is a big deal for the shingles vaccine since the typical Medicare Beneficiary who hadn’t paid their Part D deductible was paying about $200 out of pocket for the vaccine prior to 2023. Medicare now fully covers the Shingles vaccines and you will not need to pay a copay or deductible.
DTaP Vaccine:
DTaP is another common vaccine recommended for seniors. Part D fully covers this vaccine without a copay or deductible.
Other ACIP-Recommended Vaccines: If you want to see the full list of ACIP-Recommended Vaccines covered in full by Part D coverage, visit https://www.cdc.gov/vaccines/hcp/acip-recs/
Staying informed about Medicare’s coverage for vaccines is important to maintain health and well-being of beneficiaries. Understanding the distinctions between Medicare Part B and Part D coverage ensures that you can make informed decisions on how to get coverage. It is important to know that you should have a Part D plan to get access to Part D covered vaccines.
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Reference:
https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/vaccines-part-d-factsheet-icn908764.pdfhttps://www.cdc.gov/vaccines/hcp/acip-recs/
