- Yes, Medicare typically covers vaccines including RSV, shingles, Covid and Covid boosters, Tdap, hepatitis, and others under Medicare Part D.
- Since 2023, you no longer have to pay out-of-pocket for vaccines listed under the CDC’s ACIP Recommendations. This includes the most common vaccines in the country (full list below!)
- Some vaccinations are covered by Medicare Part B, while others are covered by Medicare Part D prescription drug plans. This has a few implications that you need to be aware of.
- Vaccinations covered by Medicare Part D are usually administered at no cost to you at in-network pharmacies. If you get them elsewhere like at a doctor’s office, you may have to pay out-of-pocket first, and then request reimbursement.
- You can typically get vaccinations covered by Medicare Part B at no cost to you, anywhere that accepts Medicare.
A lot of people think that turning 65 is a time to retire, relax, and give their brain a rest.
Unfortunately, Medicare might be giving you a bit more stress than you were anticipating in this stage of life!
If you aren’t aware of how Medicare covers vaccines, you could potentially miss out on getting your vaccinations covered.
That’s why we’re here to simplify this for you.
We’ve helped thousands of people understand Medicare better, and we’re excited to help you too.
In this article, we’ll go over everything you need to know to get the vaccinations you need.
Does Medicare Cover Vaccinations?
Yes, Medicare covers many common vaccines. For those vaccines, there are usually no deductibles, copays, or coinsurances that you have to make.
However, some vaccinations are covered by Medicare Part B, while others are covered by Medicare Part D, which are prescription drug plans provided by private insurance companies.
This might seem like a technicality, but it does have real-life implications that you need to be aware of.
Let’s have a closer look.
What Vaccines are Covered by Medicare Part B?
Medicare Part B typically covers flu, pneumonia, hepatitis B, and Covid shots. It also typically covers medically required vaccinations.
- Flu shots (seasonal flu and H1N1 shots) – Medicare usually covers one shot per flu season. The flu season usually runs from November to April but may start as early as October, and end as late as May.
- Pneumonia shots – Medicare normally covers two Pneumonia shots: your first pneumonia shot, and your second one a year after.
- Hepatitis B shots – Medicare Part B usually covers your hepatitis B vaccination if you are considered at risk for the virus. Otherwise, hepatitis B shots are typically covered by Medicare Part D. According to Medicare.gov, Medicare Part B covers this shot for people who:
- Have ESRD, hemophilia, or blood or body fluid contact with an infected person
- Are a client/staff member of a developmentally disabled institution
- Live with someone with hepatitis b
- Use certain injection drugs
- Are a healthcare professional with frequent contact with blood and bodily fluids
- Covid-19 vaccination and booster shots – Medicare usually covers Covid vaccines and booster shots regardless if you’re enrolled in Medicare or not—you get it at no cost to you.
- Any medically required vaccine – According to Medicareinteractive.org, if you’ve been exposed to a disease or a dangerous situation, Medicare will typically cover your shots. For example, if you’re wounded by a rusted nail, Medicare usually would cover your tetanus shot. Also, if you’re bitten by a rabid animal, Medicare Part B usually would cover your rabies shot.
As noted in the medicare.gov links above, Medicare usually covers 100% of the cost of these shots. You generally won’t be responsible for any deductibles, copays, or coinsurances as long as you get them at a facility that accepts Medicare.
However, sometimes you could be charged up to 15% more than the Medicare-approved amount, which you’ll be responsible for paying (Medicare Part B excess charge).
If you choose to enroll in a Medicare Advantage Plan, you’ll get the same vaccination coverage as Medicare Part B. Medicare Advantage Plans are required to cover these vaccines without cost-sharing methods.
What Vaccines are Covered by Medicare Part D?
Medicare Part D prescription drug plans cover most vaccinations not included in Medicare Part B. If the vaccination is also included in the CDC’s ACIP Recommendations, these should be at no cost to you.
The vaccines in the CDC’s ACIP Recommendations are:
- Anthrax
- Cholera
- COVID-19
- Dengue
- DTaP-IPV-Hib-HepB
- DTaP/Tdap/Td
- Ebola
- Hepatitis A
- Hepatitis B
- Hib
- HPV
- Influenza
- Japanese Encephalitis
- Measles, Mumps and Rubella
- MMRV
- Meningococcal
- Orthopoxviruses (Smallpox and Monkeypox)
- Pneumococcal
- Polio
- Rabies
- Rotavirus
- RSV
- Tick-Borne Encephalitis
- Typhoid
- Varicella (Chickenpox)
- Yellow Fever
- Zoster (Shingles)
For vaccinations outside this list, you may be subject to your Medicare Part D plan’s deductibles, copays, or coinsurances.
For example: if your Medicare Part D plan has a $545 deductible, you may have to spend that much out-of-pocket on medications before your insurance company covers your vaccination.
Even if you already paid the deductible, Medicare Part D plans typically have cost-sharing schemes, meaning you’ll most likely pay a copay or coinsurance for your vaccination.
Again, this only applies to vaccines not listed in the CDC’s ACIP Recommendations above.
What Changed With Medicare Part D Vaccines in 2023?
Before 2023, Medicare Part D vaccinations were typically subject to your Medicare Part D plan’s deductibles, copays, and coinsurances. This meant that there were usually out-of-pocket expenses to get these vaccinations.
However, the Inflation Reduction Act of 2022 removed cost-sharing for vaccinations included in the CDC’s ACIP (Advisory Committee on Immunization Practices) recommendations. This took effect on January 1, 2023.
That’s why today, most important vaccines are covered by your Medicare Part D insurance provider.
What’s the Difference Between Medicare Part B and D Vaccines?
Medicare Part B vaccines are usually administered in doctor’s offices, while Medicare Part D vaccines are typically given in pharmacies. Both of these are billed to different parts of Medicare, which sometimes causes confusion.
You can get your Medicare Part B vaccines at doctor’s offices that accept Medicare, and you shouldn’t have to pay for them. The provider will usually bill Medicare directly.
For Medicare Part D vaccines, you’ll usually have to go to a pharmacy in your plan’s network. This will allow them to bill your insurance company directly.
If you get the vaccine at a doctor’s office or a pharmacy outside of your Medicare Part D plan’s network, there are often two ways to get your coverage:
- You can pay upfront and then request reimbursement from your insurance company, or
- Ask the doctor’s office or pharmacy to bill your Medicare Part D insurance company directly.
Note: not all doctor’s offices and pharmacies allow option 2.
Now… if you’re going for option 2, there’s one mistake that a lot of people make:
The Medicare Part D Vaccine Mistake
If you get a vaccine at a doctor’s office or pharmacy outside your Medicare Part D plan’s network, make sure you tell them to bill Medicare Part D, NOT Medicare Part B.
Otherwise, you might find the bill in your own mailbox. Here’s how:
Since outpatient services are covered by Medicare Part B, some offices will automatically send your bill to Medicare Part B.
Medicare will normally reject this bill.
When Medicare rejects the bill, the office that provided the vaccination will likely send the bill to you instead. Some people make the mistake of paying this — thinking they have to because Medicare rejected it.
In reality, that bill just needed to be sent to Medicare Part B when it should have been sent to Medicare Part D.
That’s why if you’re getting a vaccination at a doctor’s office, make sure to tell them to bill it to Medicare Part D, not Medicare Part B!
Frequently Asked Questions About Medicare Vaccinations
Does Medicare Cover Vaccines for RSV?
Yes, prescription drug plans (Medicare Part D) typically cover RSV vaccines like Arexvy and Abryvso.
RSV, or respiratory syncytial virus, is a common virus that usually causes simple symptoms like colds. However, for people who are 65+ years old, RSV can have more severe—and potentially fatal—effects.
In 2023, Arexvy and Abryvso became the first two RSV vaccines approved by the FDA. Since these vaccines are part of the CDC’s ACIP recommendations, you shouldn’t have to pay out-of-pocket for them.
Important! One thing to remember is that RSV vaccines are covered under Medicare Part D. Medicare Part D plans are provided by private insurance companies. You can enroll in a standalone Medicare Part D Plan, or enroll in a Medicare Advantage Plan with a built-in prescription drug plan. Either way, Medicare Part D is something you enroll in separately from Original Medicare.
Even if you have Original Medicare plus a Medicare Supplement Plan, you still won’t be covered for this vaccine.
Note: if you’re enrolled in a Medicare Advantage plan, check if it includes a Medicare Part D component. If it does, you should be covered. But if it doesn’t, you may have to pay for the RSV vaccine out-of-pocket.
Does Medicare Cover Shingles Vaccines?
Yes, Shingles vaccinations like Shingrix are covered by prescription drug plans (Medicare Part D).
According to the CDC, around 1 million people get shingles every year, and people over 50 years of age are the most vulnerable to this virus.
Vaccines like Shringrix are 90% effective at preventing older adults from getting shingles. The CDC recommends getting 2 shots of the Shingrix vaccine.
If you’re enrolled in a Medicare Part D plan, you can get them at no cost to you since shingles vaccines are part of the CDC’s ACIP recommendations.
Again, keep in mind that it is not covered by Medicare Part B. So in order to get this coverage, you need to be enrolled in a separate prescription drug plan (Medicare Part D), or a Medicare Advantage plan with a built-in prescription drug plan.
Does Medicare Cover Covid Vaccines?
Yes, Medicare covers Covid vaccines and Covid booster shots. You can get these at no cost to you even if you aren’t enrolled in Medicare.
All Covid vaccinations are typically offered to everyone at no cost. You also don’t have to worry about eligibility requirements.
If you want to know the technical side of things, the vaccines are paid for by Medicare Part B.
Does Medicare Cover Tdap Vaccines?
Yes, Tdap vaccines are typically covered by prescription drug plans (Medicare Part D). If you’re enrolled in a Medicare Part D Plan, you should be able to get Tdap vaccines at no cost to you since they are also included in the CDC’s ACIP recommendations.
Tdap vaccines protect adults from tetanus, diphtheria, and whooping cough (pertussis). The CDC recommends getting a Tdap booster shot once every 10 years.
Remember, Tdap vaccinations are generally covered by Medicare Part D, the prescription drug plan part of Medicare. Since Tdap vaccines are also part of the CDC’s recommendations, you’ll likely be able to get them without worrying about Medicare Part D’s deductibles, copays, or coinsurances.
If you aren’t enrolled in a Medicare Part D plan, you may have to pay 100% out-of-pocket for the vaccine.
Note: if you are enrolled in Medicare Part B, and you find yourself at high risk for tetanus (which you can get by stepping on a rusted nail), you can get a tetanus shot at no cost to you from Medicare Part B. Otherwise, tetanus shots and Tdap vaccines are covered by Medicare Part D.
What Other Preventive and Screening Measures are Covered by Medicare?
Aside from vaccines, Medicare Part B also typically covers several preventive services. This includes:
- Abdominal aortic aneurysm screenings
- Alcohol misuse screenings & counseling
- Blood-based biomarker tests
- Cardiovascular disease screenings
- Cardiovascular disease (behavioral therapy)
- Cervical & vaginal cancer screenings
- Colorectal cancer screenings
- Depression screenings
- Diabetes screenings
- Diabetes self-management training
- Flu shots
- Glaucoma tests
- Hepatitis B shots
- Hepatitis B Virus (HBV) infection screenings
- Hepatitis C screening tests
- HIV screenings
- Lung cancer screenings
- Mammograms (screening)
- Medicare Diabetes Prevention Program
- Nutrition therapy services
- Obesity screenings & counseling
- One-time “Welcome to Medicare” preventive visit
- Pneumococcal shots
- Prostate cancer screenings
- Sexually transmitted infections screenings & counseling
- Tobacco use cessation counseling
- Yearly “Wellness” visit
Visit Medicare’s official website to learn more about these screening services.
Conclusion: Need More Help With Medicare?
Yes, Medicare covers most commercially available vaccines.
You can also get most vaccines without any out-of-pocket costs today.
However, like all things Medicare, even vaccine coverage comes with complexities that many people have a hard time with.
We hope that this article clarifies any confusion you may have had and that it helps you avoid paying for vaccinations Medicare covers!
If you need any more help with vaccinations or anything else related to Medicare, give us a call or text us at +1 877-360-6565 (TTY: 771). Our team of licensed insurance agents will be more than happy to assist you with any concerns you may have.