Preventive health care is care you receive to prevent illness, detect medical conditions, and keep you healthy. Medicare covers many preventive health care services, including routine vaccines. Today I will discuss how the different parts of Medicare cover vaccines, along with some important notes about a few common vaccines.
Point 1: Understand that most vaccines are covered by Medicare Part D
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.
Point 2: Learn which vaccines are covered by Medicare Part B
While Part D covers most vaccines, there are certain vaccinations that are always covered by Part B, such as for influenza (the flu shot), pneumonia, hepatitis B (for people at risk), and for COVID-19. Part B also covers certain reasonable and necessary vaccines to treat an injury or exposure to a disease. For example, Part B covers a tetanus shot if you step on a rusty nail, or a rabies shot if a dog bites you. 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. Please bring your red, white, and blue Medicare card with you to your vaccination appointment. Let’s review who is eligible for these vaccines and when:
First, the flu shot—Medicare covers one flu shot every flu season. The season usually runs from November through April.
Second, the 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.
Third, the 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.
Finally, Medicare Part B covers COVID-19 vaccines, including a subsequent dose or booster. Speak with your doctor to learn more about the vaccine and whether a booster or additional dose is recommended for your individual circumstances.
To discuss any concern relating to vaccine-coverage by Medicare, or to ask any questions regarding your specific situation, please 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 Act (MIPPA) program. If you are part of an agency or organization that assists seniors with medical resources, consider networking with the Medicare Information Office. Call us to inquire about our new Ambassador program.
