Original Medicare covers a few vaccines, including the annual flu shot. However, for more thorough vaccine coverage, beneficiaries can consider enrolling in a Medicare Part D drug plan. These plans typically cover a more extensive range of vaccines, such as shingles and Tdap.
Vaccines can help prevent serious illnesses and are the first line of defense for many older people. Learn more about how Medicare covers vaccinations.
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How Does Medicare Cover Vaccines?
Original Medicare covers some vaccines under Medicare Part B, which is medical insurance. Part B provides the following preventative vaccines at no cost:
- Flu shot: Medicare covers one flu shot each year
- Hepatitis B shot: Medicare covers up to 3 doses of the Hepatitis B vaccine for Medicare recipients that are at medium or high risk for contracting the infection, including those with hemophilia, end-stage renal disease (ESRD) or diabetes
- Pneumococcal: Medicare covers the vaccine to help prevent certain types of pneumonia
Part B also generally covers other immunizations related to direct exposure, or vaccines needed for treatment of an injury. For example, if a Medicare recipient falls and cuts their leg, part of their doctor’s treatment may include updating the patient’s tetanus antitoxin.
Other shots commonly ordered by physicians and typically covered by Medicare Part B include:
- Anti-rabies treatment: Medicare covers a single-dose vaccine given to patients exposed to or potentially exposed to rabies
- Botulin antitoxin: Medicare covers the vaccine needed to treat patients exposed to the botulinum toxin, which causes muscle paralysis
- Antivenin: Medicare covers the medication needed to treat patients bitten by poisonous snakes
- Immune globulin: Medicare covers the administration of the immune globulin, which is used to strengthen the body’s natural immune response and lower the risk of infection that may result from a weakened immune system
Vaccines covered by Part B do not require a copayment so long as the health care provider accepts Medicare.
How Does Medicare Advantage Cover Immunizations?
Medicare Advantage, also commonly called Medicare Part C, is coverage offered by private insurance companies approved by Medicare. All MA Plans cover the same immunizations covered by Original Medicare at minimum, but may offer additional coverages. For example, Medicare Advantage Plans may also provide additional benefits like vision and dental care, but costs and rules for accessing care differ depending on which plan you choose.
These additional benefits may also include Part D drug benefits, as many Medicare Advantage Plans bundle Part D coverage. This means those enrolled in an MA Plan may have coverage for the Tdap and shingles vaccines.
How Does Medicare Part D Cover Vaccines?
Medicare Part D is an optional prescription drug plan that offers a more robust coverage of vaccines than Original Medicare. You can get Medicare Part D coverage by choosing a Medicare Advantage Plan that includes drug coverage or by purchasing a stand-alone Medicare Part D plan. Vaccines covered by Part D includes:
- TDap (tetanus, diphtheria, and pertussis/whooping cough)
- Vaccines needed for international travel
In general, Medicare Part D covers all physician-recommended vaccines that are considered “reasonable and necessary” to prevent illness, aside from those already covered by Part B and those provided by a vaccine manufacturer that does not participate in the coverage gap discount program.
You may have to pay the cost of receiving vaccinations with Part D coverage out of pocket and get reimbursed later. Your costs may vary depending on where you receive the vaccine. If you get vaccinated at an in-network pharmacy or at your doctor’s office, you may pay less than if you received the vaccine outside of your plan’s network. The vaccination costs may go toward your deductible, or you may have a copay for certain vaccines covered by Part D.
Medicare beneficiaries may also be eligible for Medicare Extra Help. This program provides assistance with out-of-pocket drug costs for people with limited resources, such as those who have full Medicaid coverage, get Supplemental Security Income (SSI), or get help from the state paying Part B premiums.
Medicare Coverage For Newer Vaccine Needs
As the COVID-19 pandemic has shown, vaccine needs can change quickly. In addition, new innovations to vaccine delivery methods can quickly become widely available. Learn how Medicare handles newer vaccine demands.
Does Medicare Cover Oral or Nasal Spray Vaccines?
Medicare may cover FDA-approved oral and nasal spray vaccines. However, the FDA has not cleared nasal spray flu vaccines like FluMist or other Live Attenuated Influenza Vaccines (LAIVs) for people 50 and over.
If your doctor prescribes an oral or nasal spray vaccine, it must be FDA-approved, or Medicare may not provide coverage.
Does Medicare Cover the COVID-19 Vaccine and Boosters?
Medicare Part B covers the updated COVID-19 vaccine and booster shots as recommended by your health care provider. There are no out-of-pocket costs associated with receiving a COVID-19 vaccine. Your provider is not allowed to charge you an administration fee to provide access to the COVID-19 vaccine or boosters.
Regardless of how many COVID-19 boosters you’ve received, you can get the updated vaccine 8 weeks after the end of your primary vaccination series, which includes 2 doses of Moderna, Novavax, or Pfizer-BioNTech, or a single dose of Johnson & Johnson. Immunocompromised beneficiaries can receive an additional dose of the COVID-19 shot at least 28 days after they get the first shot. Medicare covers the additional cost of the second shot.
Medicare recipients who have a disability or face challenges in leaving home to get a COVID-19 shot or booster can request that Medicare send a health care provider to their home to administer the shot. There is no charge for this service.
Does Medicare Cover Monkeypox Vaccines?
There are currently 2 Monkeypox vaccines available in the United States. Monkeypox vaccines are free with Medicare, but you may have to pay an administration fee in certain medical settings. However, even if you cannot pay the administration fee, providers must give you the vaccine if it’s medically necessary.
Putting It All Together
Understanding how Medicare covers vaccines is crucial for older adults. Medicare Part B provides coverage for several preventative vaccines at no cost, including flu shots, Hepatitis B shots, and pneumococcal vaccines. Medicare Advantage may offer additional benefits, such as a wider range of covered vaccinations. Medicare Part D covers prescription drugs, including vaccines, and beneficiaries may incur varying costs depending on factors like network coverage and location.
Additionally, as vaccine needs evolve, Medicare covers newer vaccines, including the COVID-19 shot and boosters, as recommended by healthcare providers. Stay informed about your coverage to make the most of preventive healthcare under Medicare.