Medicare does pay for certain tetanus shots, depending on the type of plan a person has chosen. There are also options to help lower out-of-pocket costs or get the vaccine for free.
Medicare is a federal insurance plan. People over age 65 can get Medicare. Younger people can get Medicare if they have specific health conditions.
Medicare Part A covers inpatient care, and Part B provides cover for outpatient services.
Part B usually provides cover for vaccinations, but sometimes a person is required to have Medicare Part D for specific shots.
Medicare Part D covers prescription drugs, and private insurance companies administer these plans.
In this article, we discuss if Medicare covers tetanus shots, what the out-of-pocket expenses are, and how much tetanus shots cost.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Some people know the disease as lockjaw because one of the common signs of tetanus infection is tight jaw muscles.
According to the Centers for Disease Control and Prevention (CDC), the disease can lead to trouble swallowing and breathing, and serious complications include broken bones, blood clots, and pneumonia.
Tetanus is uncommon in the United States.
People cannot catch tetanus directly from another person. A person can contract tetanus when Clostridium tetani bacteria in the dirt, dust, or soil enter the body through cuts, grazes, or puncture wounds.
A tetanus vaccine helps prevent infection.
Medicare parts A, B, or D covers some vaccines needed to help prevent disease.
A vaccine is a shot people get to help protect against disease. Like any medication, they may experience some side effects. Some are mild, and most go away within a few days.
While limited cover is available under parts A and B, Medicare Part D covers most commercially available shots intended to prevent illness, including tetanus.
Four different vaccines protect against tetanus. Each vaccine also protects against other diseases:
- diphtheria and tetanus (DT)
- tetanus and diphtheria (Td)
- tetanus, diphtheria, and pertussis (Tdap)
- diphtheria, tetanus, and pertussis (DTaP)
The capital letter in the abbreviation means the vaccine has a full-strength dose. The lower case means the vaccine uses a smaller dose.
The DT vaccine has full-strength diphtheria and tetanus vaccines, and most babies and children receive this dosage.
The Td vaccine has full-strength tetanus and lower strength diphtheria. This vaccine is a booster, and doctors typically give it to children over 7 years old.
The Tdap contains full-strength tetanus and lower strength diphtheria and pertussis. Doctors may choose this vaccine for people aged 7 years and older. They may also give Tdap as a booster shot, but Medicare does not cover this.
Original Medicare Part B covers some vaccines, and others require a person to have Part D, which covers prescription drugs.
Medicare Part B covers the following vaccinations:
Pneumococcal: This protects against pneumococcal bacteria that cause pneumonia. Medicare Part B covers the first shot and will pay for a second if a doctor administers it at least 1 year later.
Hepatitis B: This shot protects against a liver infection spread by blood and other body fluids. Medicare Part B pays if a person is at medium or high risk for getting Hepatitis B.
Flu shot: This helps protect against seasonal flu. Medicare Part B pays for one shot every flu season.
Medicare Part D covers the following vaccinations:
Tdap: This vaccine protects against tetanus, diphtheria, and whooping cough. Medicare parts A and B do not cover the shot, but Medicare Part D will pay for the Tdap. For other shots related to tetanus, a person may wish to check their coverage with their plan provider.
Shingles: This is a painful rash that may last up to 4 weeks. The pain can last for years. Medicare parts A or B do not cover the shot, but some Medicare Part D plans do.
Part D out-of-pocket expenses
A person’s out-of-pocket costs will include their Medicare Part D premium, deductible, coinsurance, and copayment.
Medicare has set rules that companies must follow, but the private insurance company administering the plan determines most out-of-pocket costs.
Local federally funded health centers provide preventive services, including vaccines.
They may offer a sliding fee based on income. The Health and Human Services Department provide a list of health departments in each state.
The CDC publish a vaccine price list for general information. They list the price of Tdap at $46.80 for one shot.
Medicare Part B pays for several vaccines to help prevent disease. This includes the tetanus vaccination, but it does not pay for a Tdap tetanus booster.
Medicare Part D, the prescription drug plan, does cover the Tdap vaccine, and it also pays for most commercially available vaccines to prevent illness.
Local federally funded health centers may offer vaccines on a sliding scale. The amount a person pays depends on their income.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.