Even though they seem the same, some shots and vaccines are covered by your medical coverage (Medicare Part B, or coverage you have through a private insurance company), while others are covered by Medicare plans that offer prescription drug coverage (Part D). Here’s what you need to know about vaccine coverage and vaccine eligibility.
Not sure what type of Medicare plan you have? Call your plan’s Member Services team to find out.
Medicare vaccine coverage through Part B
If you have Original Medicare Parts A and B, or a Medicare plan from a private insurance company, your Part B medical coverage usually takes care of the most common immunizations. Private Medicare health plans also cover additional vaccines through their Part D benefit.
You might wonder why vaccines are covered in two different ways. It’s because of how the Medicare program has changed over the years. Part D wasn’t available until 2006, so before that Part B offered the only Medicare vaccine coverage. Those same vaccines are still covered by Part B today.
In some cases, your Part B medical coverage will cover certain vaccines if you’re at risk of getting a related disease or illness. If you have Original Medicare, it’s easy to check if your vaccine is covered. If you get your Medicare benefits through a private insurance company, contact them directly to see if your vaccine is covered.
Vaccines covered under medical coverage
- Flu shots
- Pneumonia vaccine
- Hepatitis B, if you are at high or intermediate risk
- Certain vaccines based on possible exposure – like rabies or tetanus
Vaccine coverage through Medicare Part D
The Inflation Reduction Act of 2022 made important changes to coverage of vaccines under Medicare Part D. Because of this, starting Jan. 1, 2023, Medicare beneficiaries won’t have to pay a deductible or any out-of-pocket costs for vaccines that the Centers for Disease Control and Prevention (CDC) recommends for adults. This new law helps make crucial vaccines cheaper and more accessible.
The risk of getting shingles increases as you age. Fortunately, the Shingrix vaccine for shingles is covered under Medicare Part D. If you have Part D coverage, you’ll be able to get the Shingrix vaccine for a $0 copay starting on Jan. 1, 2023.
If your doctor recommends you get a vaccine, check first with your insurance company to see:
- If the vaccine is covered
- If the vaccine is covered under your medical coverage or prescription drug coverage
- If it’s affordable for you. Your insurance may not cover the entire cost if you don’t have Part D coverage or if the vaccine isn’t recommended by the CDC
Is the COVID-19 vaccine covered by Medicare?
Medicare Part B covers all FDA-authorized COVID-19 vaccines at no charge to you. This includes any deductibles, copayments or administration fees by your provider. The CARES Act made this the law as of March 2020.
The COVID-19 vaccine is also covered by Medicare Advantage or Cost plans. At a minimum, these plans are required to cover everything Original Medicare does, and many cover more services.
Knowing how your vaccines are covered can help you estimate how much you’ll be responsible for paying, which makes it easier to budget your health care costs. And remember, you can always call your Member Services team with any questions.