Original Medicare does not cover routine tetanus shots. Beneficiaries who want to keep their tetanus vaccinations up to date are responsible for paying for booster shots out of pocket unless they have other coverage.
However, Medicare Part D, an optional prescription drug benefit, covers routine vaccinations, including tetanus shots. Simultaneously, this treatment is often included in Medicare Advantage plans.
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Understanding Tetanus — And How Vaccines Can Help
Tetanus is an infection caused by Clostridium tetani, a bacteria that’s found in soil, dust, and manure. The bacteria enter your body through breaks in your skin, such as burns or puncture wounds. Once inside, they produce toxins that can cause serious health problems. Fortunately, a vaccine for tetanus is widely available.
The tetanus shot is usually bundled with other immunizations. The Tdap shot protects against tetanus, diphtheria, and pertussis. There’s also the Td shot, which protects exclusively against tetanus and diphtheria. The effectiveness of the combination vaccines is very high.
The Centers for Disease Control and Prevention (CDC) recommends a 5-dose series for young children, plus a booster shot at around 11 to 12 years of age. For adults, the CDC recommends another booster shot every ten years.
As far as how the guidance applies to those on Medicare, Original Medicare helps beneficiaries stay up to date with their tetanus vaccinations. However, there are coverage limitations to be aware of.
Limitations On How Original Medicare Covers Tetanus Shots
Unlike Part D, Original Medicare does not cover tetanus shots as a routine, preventive treatment. However, Part B may cover the tetanus shots beneficiaries need as part of the treatment for an injury.
Medicare considers tetanus shots to be medically necessary following a high risk wound. High risk wounds are deep and/or contaminated with dirt, feces, or saliva. For example, if you stepped on a nail while gardening, Medicare would likely cover a tetanus booster shot.
For tetanus shots covered under Part B, the Part B deductible applies. For 2023, it’s $226 per year. After the deductible, beneficiaries pay a 20% coinsurance for doctor services, including tetanus shots.
What Vaccines Does Original Medicare Cover?
While Original Medicare does not cover routine tetanus shots, it covers four preventive vaccines at no cost to the patient; this includes the Part B deductible or coinsurance. Here’s a look at the four vaccines Original Medicare covers and who can get them:
- Influenza: Medicare covers a preventive flu shot once per flu season for all beneficiaries.
- Pneumonia: Medicare covers pneumococcal pneumonia shots for beneficiaries who are 65 or older. It also covers the shots for people under 65 with certain underlying medical conditions, such as chronic lung disease.
- Hepatitis B: Medicare covers Hepatitis B shots for beneficiaries at medium or high risk of getting the disease. People at risk include those with diabetes or End-Stage Renal Disease.
- COVID-19: Medicare covers one updated COVID-19 vaccine for beneficiaries who received the original series. People who are immunocompromised or 65 and older can get one additional shot.
How Medicare Advantage Covers Tetanus Shots
Medicare Advantage is a popular alternative to Original Medicare offered by private companies. At a minimum, Medicare Advantage plans cover Part A and Part B benefits, but they often provide extra benefits that are not part of Original Medicare. The majority of plans include Part D drug coverage, which covers routine vaccinations.
In plans that include Part D, beneficiaries have coverage for any vaccine that’s both reasonable and necessary to prevent illness. That includes routine tetanus boosters when given on the recommended schedule.
While most Medicare Advantage plans include prescription drug coverage, some do not. Suppose your plan does not include Part D, and want drug coverage. In that case, you can switch during the Medicare Open Enrollment Period (Oct. 15 to Dec. 7) or Medicare Advantage Open Enrollment Period (Jan. 1 to Mar. 31).
How Medicare Prescription Drug Plans (Part D) Cover Tetanus Shots
Medicare Part D is optional prescription drug coverage for everyone with Medicare. It’s often included in Medicare Advantage plans. People with Original Medicare can buy a standalone Part D plan. Part D covers all vaccines on the market in the U.S., except for the four covered by Part B.
Vaccines are covered when they’re reasonable and necessary to prevent illness. The coverage includes both the vaccine itself and the cost of administering the shot. Beneficiaries do not pay coinsurance or a deductible when they receive vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP). For adults, ACIP recommends tetanus boosters once every ten years throughout life.
Part D plans work with a network of pharmacies, and members typically pay less when using in network pharmacies. Doctor’s offices are considered out of network. However, doctors can agree to accept the Part D plans’ payment in full without joining the network.
What Is the Cost of a Tetanus Shot?
The cost of getting a tetanus shot without insurance varies depending on location, clinic, and type of combination vaccine. Based on major pharmacies’ posted prices, consumers can expect to spend around $55 to $115 per dose of a tetanus-containing vaccine.
The cost of tetanus shots is much more affordable for people with drug coverage through Medicare Advantage or a Part D plan. Beneficiaries do not pay coinsurance or a deductible when receiving tetanus boosters, as ACIP recommends.
How to Get Help Paying for Tetanus Vaccine Without Medicare
Medicare Advantage and Part D are not the only ways to get help paying for tetanus shots. Many other resources help Medicare beneficiaries reduce the cost of tetanus shots, including:
- Medicaid: Medicaid, which provides health coverage to low-income Americans, typically covers the full cost of vaccines recommended by ACIP. Contact your state Medicaid agency for details.
- Community health centers: These nonprofit clinics offer sliding scale fees to help low income people access necessary care, like vaccines. In Los Angeles, for example, options include the Central City Community Health Center and the Chinatown Service Center.
- Community programs: Local health departments typically offer free or low cost vaccine clinics. In Houston, for example, the health department runs four clinics that provide vaccinations.
- TRICARE: If you or your spouse served in the U.S. military, TRICARE is another option to consider. The program covers age-appropriate vaccines at no cost to members.
Putting It All Together
Tetanus is a potentially life-threatening condition, but fortunately, an effective vaccine is widely available. While Original Medicare does not cover routine tetanus shots, it does cover the shots beneficiaries need as part of treatment for an injury.
Part D drug coverage, whether it’s from a standalone plan or a Medicare Advantage plan, helps beneficiaries pay for many routine vaccinations, including the tetanus booster. For more information about tetanus and the tetanus shot, talk to a trusted healthcare provider or insurance agent.