Preventive care is care you receive to prevent illness, detect medical conditions, and keep you healthy. Medicare covers many preventive services, including vaccines. This blog discusses how the different parts of Medicare cover vaccines, along with some important notes about a few common vaccines.
First, we should understand that most vaccines are covered by Medicare Part D.
If your provider recommends that you get a vaccine, in most cases it will be covered by your Part D prescription drug plan (or Medicare Advantage Plan with prescription drug coverage). Part D plans must include most commercially available vaccines on their list of covered drugs, including the vaccine for shingles. The amount you pay for your vaccine may vary depending on where you get vaccinated. Be sure to check your plan’s coverage rules and see where you can get your vaccine at the lowest cost. Typically, you will pay the least for your vaccinations at an in-network pharmacy or at a doctor’s office that can bill your Part D plan for the entire cost of the vaccination process. When you get a vaccine at your doctor’s office, ask the provider to call your Part D plan first to find out if the provider can bill your Part D plan directly. If this is not possible, your provider may bill you for the entire cost of the vaccine, and you will have to request reimbursement from your Part D plan.
While most vaccines are covered by Part D, there are certain vaccinations that are always covered by Part B, like the flu shot, pneumonia shot, hepatitis B shot, and the COVID-19 vaccine. Part B also covers vaccines after you have been exposed to a dangerous virus or disease. For example, Part B should cover a tetanus shot if you step on a rusty nail, or a rabies shot if you are bitten by a dog. If you qualify for one of these vaccinations, Original Medicare covers the full cost of the vaccine when you receive the service from a participating provider, and Medicare Advantage Plans cannot apply deductibles, copayments, or coinsurance when you see an in-network provider. This means you pay nothing. Let’s review who is eligible for these vaccines and when:
The flu shot: Medicare covers one flu shot every flu season. The season usually runs from November through April.
The pneumonia shot: Medicare covers two separate pneumonia vaccines. Part B covers the first shot if you have never received Part B coverage for a pneumonia shot before. You are covered for a different, second vaccinations one year after receiving the first shot.
The hepatitis B shot: Medicare covers the hepatitis B vaccine if you are at medium or high risk for hepatitis B, a virus that attacks the liver and can cause chronic liver disease. If you are at low risk for hepatitis B, the shot will be covered under Part D.
Finally, let’s see how Medicare covers the COVID-19 vaccine.
Original Medicare Part B covers COVID-19 vaccines, including an additional dose for certain at-risk populations, regardless of whether you have Original Medicare or a Medicare Advantage Plan. You will owe no cost-sharing, meaning you should pay nothing for the shot(s). Speak with your health care provider to learn more about the vaccine and whether a booster is recommended for your individual circumstances. You should bring your red, white, and blue Medicare card with you to your vaccination appointment, even if you have a Medicare Advantage Plan. If you do not have your card on you, your vaccine provider will ask you for your Social Security number so that they can look up your Medicare information.
How should you take action with this information?
Ask your doctor if you are up to date on your vaccines and if they recommend you receive any vaccines at this time.
Contact your Part D plan or Medicare Advantage Plan to learn which pharmacies are in-network and if you meet the eligibility requirements for a vaccine you may receive.
Contact your local State Health Insurance Assistance Program (SHIP) if you have questions about Medicare’s coverage of vaccines. Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted).
Still have questions?
Your SHIP is here for you! You can contact your SHIP for questions about your Medicare coverage and any problems that arise with it. SHIP counselors are government funded to provide trusted, unbiased Medicare counseling at no cost to you. (Depending on your state, your SHIP may go by another name.)
Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted).
Download Handout on Medicare Coverage of Vaccines
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