Medicare offers coverage for many vaccines and immunizations, often with minimal or no out-of-pocket expenses. Understanding the specifics of your coverage is essential, as certain vaccines fall under medical coverage (Medicare Part B or private insurer plans) or prescription drug coverage (Part D).
Let’s examine the distinctions between Part B and Part D coverage, identify the vaccines typically covered by each, and provide essential information about vaccine eligibility.
Medicare Vaccine Coverage Through Part B
If you have Original Medicare Parts A and B, or a Medicare plan through a private insurance company, your Part B medical coverage generally handles the most common immunizations. Private Medicare health plans extend coverage to additional vaccines via their Part D benefit.
The dual coverage approach stems from the fact that Medicare Part D was introduced in 2006. Before that, Part B provided Medicare vaccine coverage, and continues to cover the same vaccines today.
Vaccines Covered Under Medical Coverage (Part B)
In specific scenarios, your Part B medical coverage will cover certain vaccines if you face a heightened risk of contracting a related disease or illness. If you have Original Medicare, you can easily verify if a vaccine is covered through the Medicare website.
This image shows a person receiving a flu shot, a common vaccine often covered under Medicare Part B, particularly for those at risk.
Common vaccines covered by Medicare Part B include:
- Flu (influenza) shots: Annually covered to protect against seasonal influenza.
- Pneumococcal shots: To prevent pneumonia, especially for seniors and those with specific health conditions.
- Hepatitis B vaccine: Sometimes covered if you are at medium or high risk of contracting hepatitis B.
- COVID-19 vaccine: Covered at no cost to you, including any deductibles, copayments, or administration fees.
(Note: While the hepatitis B vaccine is sometimes covered under Medicare Part B, the hepatitis A vaccine is covered under Medicare Part D.)
Vaccine Coverage Through Medicare Part D
The Inflation Reduction Act of 2022 brought significant changes to Medicare Part D vaccine coverage. Now, Medicare beneficiaries do not pay a deductible or out-of-pocket costs for vaccines recommended for adults by the Centers for Disease Control and Prevention (CDC). This legislation significantly enhances the affordability and accessibility of vital vaccines.
Shingles Vaccine Coverage (Shingrix)
The risk of shingles increases with age. Fortunately, the Shingrix vaccine for shingles is covered under Medicare Part D. With Part D coverage, you can receive the Shingrix vaccine for a $0 copay.
This image shows a box of Shingrix vaccine, emphasizing its coverage under Medicare Part D, which often includes a $0 copay.
Medicare Part D Now Covers the RSV Vaccine
Medicare Part D now fully covers vaccines recommended by the CDC for adults over 65, including the RSV vaccine. Since the Advisory Committee on Immunization Practices (ACIP) recommends it for adults 60 and older, Medicare Part D will cover your costs as long as you have Medicare Part D coverage.
Does Medicare Cover Travel Vaccinations?
Medicare typically does not cover travel-specific vaccines like typhoid or yellow fever shots. This exclusion is due to requirements stipulating that care must be deemed “reasonable” or “medically necessary.”
This image represents a map with push pins marking various travel destinations, highlighting the need for travel vaccinations that are often not covered by Medicare.
These vaccines are usually not considered medically necessary within the standard Medicare framework. If you seek extra protection before traveling, you can still obtain these vaccines, but you will likely need to pay out of pocket. Contact your healthcare provider or a travel clinic for details.
Confirming Your Vaccine Coverage
When your doctor recommends a vaccine, always verify coverage with your insurance company. They can confirm whether the vaccine:
- Is covered under your plan.
- Falls under medical or prescription drug coverage.
- Is affordable for you. Coverage may be incomplete without Part D or if the CDC does not recommend the vaccine.
Understanding your vaccine coverage helps you anticipate healthcare costs and budget accordingly. Contact your Member Services team for any questions. While “Does Medicare Cover Travel Vaccinations” is usually no, understanding what is covered will save you money.
