What vaccines does Medicare pay for?
Also: Watch for COVID-19 Medicare fraud
December 1, 2021 | View PDF
Preventive healthcare is care you receive to prevent illness, detect medical conditions, and keep you healthy. Medicare covers many preventive healthcare services, including vaccines. Today I will discuss how the different parts of Medicare cover vaccines, along with some important notes about a few common vaccines.
Part D coverage
If your provider recommends that you get a vaccine, in most cases this service will be covered by your Part D prescription drug plan. Part D plans must include most commercially available vaccines on their list of covered drugs (the formulary), including the vaccine for shingles. The amount you pay for your vaccine may vary depending on where you get vaccinated. Be sure to check your plan’s coverage rules and see where you can get your vaccine at the lowest cost. Typically, you will pay the least for your vaccinations at an in-network pharmacy or at a doctor’s office that can bill your Part D plan for the entire cost of the vaccination process. When you get a vaccine at your doctor’s office, ask the provider to call your Part D plan first to find out if the provider can bill your Part D plan directly. If this is not possible, your provider may bill you for the entire cost of the vaccine, and you will have to request reimbursement from your Part D plan.
Part B coverage
While most vaccines are covered by Part D, there are certain vaccinations that are always covered by Part B, like the flu shot, pneumonia shot, hepatitis B shot, and the COVID-19 vaccine. Part B also covers vaccines after you have been exposed to a dangerous virus or disease. For example, Part B should cover a tetanus shot if you step on a rusty nail, or a rabies shot if you are bitten by a dog. If you qualify for one of these vaccinations, Original Medicare covers the full cost of the vaccine when you receive the service from a participating provider. This means you pay nothing. Let’s review who is eligible for these vaccines and when:
Flu shot: Medicare covers one flu shot every flu season. The season usually runs from November through April.
Pneumonia shot: Medicare covers two separate pneumonia vaccines. Part B covers the first shot if you have never received Part B coverage for a pneumonia shot previously. You are also covered for a different, second vaccination one year after receiving the first shot.
Hepatitis B shot: Medicare covers the hepatitis B vaccine if you are at medium or high risk for hepatitis B, a virus that attacks the liver and can cause chronic liver disease. If you are at low risk for hepatitis B, the shot will be covered under Part D.
COVID-19 vaccine: Medicare Part B covers COVID-19 vaccines, including an additional dose or booster for certain at-risk populations and people 65 or older. You will owe no cost-sharing, meaning you should pay nothing for this service. Speak with your doctor to learn more about the vaccine and whether a booster or additional dose is recommended for your individual circumstances. Please bring your red, white and blue Medicare card with you to your vaccination appointment.
Avoiding COVID-19 Medicare fraud
Scammers quickly adapt their schemes to our changing world. Here are some tips to help protect yourself from potential fraud concerning COVID-19:
Medicare has not issued a “COVID-19 insurance card” and anyone contacting you about this is likely attempting to steal your information.
Be suspicious of COVID-19 related surveys that offer money or gifts in exchange for personal, medical or financial information. It’s probably a scam.
Remember that you should not be charged for the COVID-19 vaccine.
Contact your doctor or trusted health care providers if you would like to receive a COVID-19 vaccine or are experiencing potential symptoms of COVID-19.
For any Medicare related questions, contact the State of Alaska Medicare Information Office at 800-478-6065 or 907-269-3680; our office is also known as the State Health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers (MIPPA) program.
Sean McPhilamy is a volunteer and Certified Medicare Counselor with the Alaska Medicare Information Office.