- Medicare Part B covers many vaccines, including for the flu and pneumonia.
- Medicare Part D may cover vaccines that Part B doesn’t.
- Some providers will bill Medicare directly; other times, you must fill out a claim with Medicare.
Vaccines can help prevent illness and injury, which is why Medicare often helps cover these costs. Medicare covers the costs of several vaccines (and their administration), including those for the flu, hepatitis B, and pneumonia.
Keep reading to find out which parts of Medicare cover these vaccines and whether you’re up to date on the vaccines you need.
Vaccines are important for preventing illness and keeping you well. Because vaccines may get less effective over the years, you may need to talk with your doctor about how frequently you should get certain ones.
Medicare Part B is the part of original Medicare that covers medical costs. It also covers several immunizations. These include:
- hepatitis B vaccines (for those at intermediate or high risk for the condition — but if you don’t meet the criteria, you still may be able to get the vaccine under your Medicare Part D prescription drug plan)
- influenza (flu) vaccine
- pneumococcal (pneumonia) vaccine
- vaccines related to treatment of an injury (such as tetanus or rabies)
- vaccines related to reducing your risk for exposure to a condition or disease
A vaccine for the 2019 novel coronavirus (SARS-CoV-2) isn’t currently available. But many pharmaceutical companies are developing vaccines in the hopes of protecting against the COVID-19, the disease caused by the virus.
A vaccine could put an end to a pandemic that has taken thousands of American lives. And whenever a coronavirus vaccine is available, Medicare and Medicare Advantage will cover the costs, according to the CARES Act.
The CARES Act states that a person with Medicare will not have to pay any cost-sharing for the vaccines. This means you won’t have to pay a copayment or deductible toward getting a coronavirus vaccine.
Medicare divides its coverage into parts, and each part covers specific medical costs. Here’s what each Medicare part may cover — or not cover — when it comes to vaccines:
- Part A. Part A is the part of original Medicare that covers hospital and inpatient stays. It doesn’t usually cover vaccines. Even if you’re in the hospital and get a flu shot (or other shot), the hospital will still bill your Medicare Part B plan.
- Part B. Part B is the portion of original Medicare that pays for most medical costs. The vaccines that Medicare covers are listed above.
- Part C. Medicare Advantage (Part C) is an alternative to original Medicare (parts A and B). Medicare Advantage plans must cover all the vaccines that original Medicare does.
- Part D. Part D is the portion of Medicare that pays for prescription drugs. It will cover vaccines if Medicare Part B doesn’t cover them. Your Part D formulary (list of covered medications) should explain which vaccines your plan covers.
- Medigap. Medigap is Medicare supplement insurance that helps cover the out-of-pocket costs related to healthcare. Medigap doesn’t pay for vaccine costs because you don’t have out-of-pocket costs when getting vaccines approved under Part B.
It’s always a good idea to know how Medicare may pay for your vaccine before you get it. Sometimes, Medicare may have certain rules: For example, you might need to get the vaccine from a certain company or at a Medicare-approved facility.
The cost for vaccines depends on which portion of Medicare is paying and what the vaccine is.
You won’t pay anything for vaccines that Medicare Part B covers. But if you have Medicare Part C (Advantage), you should check with your insurance plan.
You may need to get your vaccine from a plan-approved provider or pharmacy. If you’re following the rules of your Medicare Advantage plan, you shouldn’t have to pay anything for your vaccine.
If you get a vaccine that Part D covers, your Part D insurance company will negotiate a price that includes the vaccine costs and its administration. The costs include:
- dispensing fee
- sales tax
- vaccine administration fee
- vaccine ingredient costs
Your doctor (or whoever provided the vaccine) will bill your Part D plan directly. You may be responsible for costs that include a copayment or coinsurance.
Sometimes, your plan may require you to pay your provider up front for the Medicare Part D vaccine, then submit a claim to your Part D plan for reimbursement. When this is the case, you may want to contact your plan before getting the vaccine just to confirm your coverage.
Are you up to date on your vaccines?
Centers for Disease Control and Prevention (CDC)makes recommendations based on age for immunizations. Read this list to make sure you’re up to date.
Vaccines recommended for people ages 65 or over or those who haven’t had a past infection:
- Influenza vaccine: 1 dose every year
- Tdap booster: every 10 years or 1 initial dose if you haven’t ever had the vaccine
- Zoster (shingles) vaccine: either live or recombinant (preferred) vaccine
- Pneumococcal vaccine: 1 dose at age 65
The CDC recommends these vaccines if you have a risk factor for the condition or other indication that a doctor may suggest. These include:
- Varicella: 2 doses if you didn’t receive immunization before age 65
- Hepatitis A: 2 or 3 doses, depending on the vaccine type
- Hepatitis B: 2 or 3 doses, depending on the vaccine type
- Meningococcal A, C, W, Y: 1 to 2 doses; may require boosters
- Meningococcal B: 2 to 3 doses; may require boosters
- Haemophilus influenzae type b: 1 to 3 doses as a doctor recommends
- Vaccines can help keep you well by preventing many illnesses that used to make people seriously ill.
- Medicare Part B covers several of these costs, and Medicare Part D often covers the other costs.
- Call your plan to make sure you’re getting your vaccine from an approved provider; this can help keep your costs at a minimum.
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