What Vaccines Does Medicare Cover?
Medicare Part B covers shots, vaccines and immunizations most people need, including a yearly flu shot. These preventive services are provided at no cost to you. Medicare Part D prescription drug plans can cover some costs of other common shots, including the shingles vaccine and the Tdap vaccine.
Which Vaccines Does Medicare Part B Cover?
Medicare Part B covers several vaccines that play a vital role in preventing disease and maintaining health. These vaccines and other preventive services are available at no cost to you.
Other vaccines may be covered by Medicare Part B if the shot is related to a doctor’s treatment of an injury or illness.
- Flu Shot
- Medicare Part B covers one flu shot each flu season for free. The shot is available in both a regular strength dose and a high strength dose for extra immunity.
- Pneumococcal Vaccinations
- Medicare covers two different pneumococcal shots to protect you from different strains of a bacteria that can cause pneumonia. Many people need only one shot in their lifetime. However, a second, different shot is covered 11 months after the first shot.
- Hepatitis B
- Medicare covers Hepatitis B shots for people at medium or high risk for the disease. Check with your doctor to see if you qualify for a free Hepatitis B shot.
While Medicare Part B pays for these three vaccines, many others are covered under Medicare Part D prescription drug plans.
For example, Part B does not cover the vaccine for shingles, the meningococcal vaccine and the tetanus, diphtheria and pertussis (Tdap) shot.
Some shots are only covered by Medicare if they are related to a doctor’s specific treatment of an injury or illness.
For example, Medicare would cover a rabies shot if you were bit by a dog or a tetanus shot if you stepped on a rusty nail.
Vaccinations Covered by Medicare Part D
Medicare prescription drug (Part D) plans pay for commercially available vaccines not already covered by Medicare Part B.
According to the Centers for Medicare and Medicaid Services, a medical professional must deem the shot reasonable and necessary to prevent illness.
Part D plans specify which drugs and vaccines are paid for using a formulary. A formulary is a list of drugs and shots covered by a plan. Formularies are designed to meet the needs of most members.
However, your plan may still cover certain new vaccines, even if it does not appear in the formulary.
Part D plans have special rules, such as prior authorization from your doctor or quantity limits. Contact your plan provider for coverage details.
Medicare Advantage (Part C) plans that include prescription drug coverage also usually cover all commercially available vaccinations.
- Shingles vaccine
- MMR (measles, mumps and rubella) vaccines
- Hepatitis A and Hepatitis B vaccines for low-risk patients
- BCG (Bacille Calmette-Guerin) vaccine for tuberculosis
- Meningococcal vaccines
- Tdap (tetanus, diphtheria and pertussis) vaccine
Costs for Part D-Covered Vaccinations
How much you pay for Part D shots can vary depending on where you get vaccinated.
You can receive vaccinations at an in-network pharmacy or your doctor’s office. Your doctor can also coordinate with a pharmacy to bill your Part D plan for the cost of the vaccination process.
In these instances, you should only owe your plan’s coinsurance or copay for the drug and vaccine.
It’s important to check your plan’s coverage rules to find out the most affordable place to get vaccinated.
6 Cited Research Articles
- Centers for Medicare & Medicaid Services. (2019, June). Medicare Part D Vaccines. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Vaccines-Part-D-Factsheet-ICN908764.pdf
- Center for Benefits Access. (2017, November). Vaccines: What Medicare Pays For. Retrieved from https://www.ncoa.org/wp-content/uploads/medicare-vaccines.pdf
- Centers for Disease Control and Prevention. (2017, March 31). How to Pay for Vaccines. Retrieved from https://www.cdc.gov/vaccines/adults/pay-for-vaccines.html
- Medicare.gov. (n.d.). Flu shots. Retrieved from https://www.medicare.gov/coverage/flu-shots
- Medicare.gov. (n.d.). Hepatitis B shots. Retrieved from https://www.medicare.gov/coverage/hepatitis-b-shots
- Medicare.gov. (n.d.). Pneumococcal shots. Retrieved from https://www.medicare.gov/coverage/pneumococcal-shots