Vaccinations are an important part of healthcare. They can prevent people from catching diseases that could otherwise damage their health.
Medicare’s vaccine coverage helps eligible members reduce their risk of contracting diseases, and at a minimal cost.
In this article, we look at Medicare’s vaccination coverage and how Medicare members can use this coverage to improve their immunity against disease for better health outcomes.
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.
The various parts of Medicare cover different vaccines. This guide outlines the vaccines available under the different Medicare sections.
Medicare Part B covers:
- Influenza vaccines including both seasonal flu vaccine and the H1NI (swine flu) vaccine
- Pneumococcal vaccines
- Hepatitis B vaccine for eligible at-risk people
If people have an accident that exposes them to a serious disease, they may also receive vaccination as part of their treatment.
If a person is bitten by a dog or wild animal, then Medicare covers rabies vaccinations.
Medicare also provides tetanus vaccinations to people who require them, such as when someone stands on a rusty nail or has a deep cut.
All Medicare Advantage plans include the vaccines covered by Medicare Part B. Most Medicare Advantage plans also cover extra vaccines included under Medicare drug plans (Part D).
Medicare calls these special Medicare Advantage plans MA-PDs. They usually cover all commercial vaccines exempt from Part D.
Medicare does not cover vaccines for children. However, the
This federal government program makes vaccines accessible for the following children:
- Children enrolled in Medicaid
- Uninsured children
- Underinsured children
- American Indian or Native Alaskan children
The Vaccines for Children program covers childhood vaccines protecting against the following diseases:
- Hepatitis A
- Hepatitis B
- Hemophilus influenza type B (HIB)
- Human papillomavirus (HPV)
- Pneumococcal (for pneumonia)
- Whooping cough
Vaccines are free under the Vaccines for Children program. However, health care providers may charge fees for clinic visits or administering shots.
Medicare Part D covers all the vaccines available through Part B along with any other commercially-available vaccine. Medicare drug plans often include vaccines for:
- Zoster (shingles)
- Measles, mumps, rubella (MMR)
- Tetanus, diphtheria, pertussis (TDAP)
Medicare drug plans list most of their included vaccines in their formularies. However, plans may also cover some new preventative vaccines before listing them.
A person can check with their plan provider to learn whether their plan covers new vaccines.
All Medicare members qualify for influenza and pneumococcal vaccines, which can protect against the various strains of influenza and pneumonia.
Medicare members with a medium to high risk of contracting hepatitis B also qualify for a preventative vaccine. Patients in the following categories usually qualify for the hepatitis B vaccine:
- people with hemophilia, diabetes, or end stage renal disease
- people living with someone with hepatitis B
- people working in health care
- anyone exposed to blood or bodily fluids at work
Some other factors can also increase the likelihood of contracting hepatitis B. Anyone concerned about their risk should ask their doctor about their vaccine eligibility.
After injuries or exposure, people with Medicare can also receive tetanus and rabies preventative vaccines.
People with a Medicare Advantage plan (covering prescription drugs) and Medicare Part D are also eligible for other vaccines. Anyone on these plans can access these commercially-available vaccines.
Different vaccines covered under Medicare Part B have different coverage amounts, for various reasons.
- The influenza vaccine changes annually to adapt to new and changing strains. For this reason, people covered under Medicare can get a new influenza shot each year, which covers an individual for the entire influenza season.
- Most people receive one pneumococcal vaccine under Medicare in their lifetimes. However, high-risk groups can receive a booster shot every five years. These include people with spleen and kidney conditions. Doctors advise their patients whether they need boosters.
- The hepatitis B vaccine is a series of two, three, or four shots. Doctors advise their eligible patients which course is right for them.
As Medicare Advantage and Medicare Part D plans vary, their vaccine coverage also varies. People with these plans should contact their providers to learn more about their vaccine coverage. Coverage is always adequate for preventing the diseases the included vaccines combat.
Patients incur two potential costs for vaccines: the cost of the vaccine itself and administration fees. These fees include the cost of administering vaccines and face-to-face consultations.
Under Medicare Part B, influenza and pneumococcal vaccines are free. Some other vaccines, such as vaccines for rabies and tetanus, are also free for qualifying patients.
Influenza and pneumococcal vaccines are not subject to Medicare Part B deductibles or coinsurance. Medicare pays 100% of the allowable amounts, but this may not cover all the fees. Medicare also pays two separate fees for patients receiving both shots on the same day.
The hepatitis B vaccine is subject to a deductible and coinsurance. Medicare pays 80% of the amount owing after the patient’s deductible.
Medicare Advantage and Medicare Part D providers cover their vaccine and clinic fees. Patients usually pay these costs then file claims for their out-of-pocket expenses. Coverage amounts vary between plans and providers.
Medicare ensures at-risk people can receive vaccinations at a minimal cost. Individual costs and coverage vary from plan to plan. However, all Medicare plans provide adequate vaccination coverage.
Part B covers common vaccinations for influenza, pneumococcal, and hepatitis B, and vaccines protecting injured and at-risk patients from other conditions such as rabies and tetanus. All other commercial vaccines are available through select Medicare Advantage and Part D plans.
People should ensure their Medicare plan provides the right vaccination coverage. All plans cover basic vaccinations, such as flu shots. Others provide more specialized vaccinations such as protection against shingles. Doctors can advise their patients which Medicare plan will suit them best.