Speak with a Licensed Insurance Agent

(888) 335-8996
Search
Close this search box.

What Vaccines Does Medicare Part B and Part D Cover?

Summary: There are multiple vaccines available to help prevent you from getting serious illnesses. It is important to understand if the vaccine you receive is covered by Medicare Part B or Part D. Estimated Read Time: 6 mins

Find Medicare Plans in 3 Easy Steps

We have helped over 250,000 Medicare clients find their Medicare coverage

Table of Contents:

  1. What Vaccines are Covered by Medicare Part B?
  2. What Vaccines are Covered by Medicare Part D?
  3. Does Medicare Cover Flu Shots?
  4. Does Medicare Cover Shingles Shots?
  5. Does Medicare Cover Tdap Vaccine?
  6. Does Medicare Part D Cover Hepatitis A Vaccine?
  7. Does Medicare Cover the Pneumonia Vaccine?
  8. Does Medicare Cover the RSV Vaccine?

As we age, it’s important to take care of our health. Many adults and seniors tend to put their health on the back burner. Luckily, various vaccines are on the market that help build the body’s immune system.

Medicare Part B and Medicare Part D prescription drug plans both cover the cost of vaccines. The plan providing coverage depends on the type of immunization.

What Vaccines are Covered by Medicare Part B?

Medicare Part B covers many of the most common vaccines under preventive services.

Part B covers flu shots, Hepatitis B shots, pneumonia shots, and the Covid-19 vaccine. Part B also covers any shot you need due to an injury. For example, Part B would cover a rabies shot if you got bit by a wild animal.

You will not pay any out-of-pocket coinsurance or deductible costs for a vaccine covered under Medicare Part B if you get the vaccine from any pharmacy or doctor who accepts Medicare assignment.

What Vaccines are Covered by Medicare Part D?

Medicare Part D covers any commercially available vaccine that isn’t covered by Medicare Part B. These vaccines must be medically necessary to be covered.

Usually, a prescribed drug must be available in the Part D plan’s specific formulary to be covered. However, as long as a doctor prescribes a vaccine listed under Part D to prevent a patient’s illness, the plan must cover it regardless of any formulary.

The three vaccines currently covered under Medicare Part D are the shingles vaccine, the tetanus-diphtheria-whooping cough (Tdap) vaccine, and the RSV vaccine.

Find Medicare Plans in 3 Easy Steps

We have helped over 250,000 Medicare clients find their Medicare coverage

Part D may also cover any necessary vaccines if you plan on any international travel.

It’s important to note that Part D vaccines can occasionally be covered by Part B, depending on the circumstances. If you need a tetanus shot because you accidentally punctured yourself with a rusty nail, then it would be covered under Part B. However, if you want a tetanus booster shot that’s unrelated to illness or injury, it would be covered under Part D.

As of the start of 2023, Medicare Part D beneficiaries pay no out-of-pocket costs for vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). You can go to any pharmacy or doctor who accepts Medicare and get a Part D covered vaccine at no cost to you.

You would have no coinsurance or deductible costs, which makes cost sharing for ACIP-approved vaccines under Part D just like coverage for Part B vaccines. Your only potential cost for a Part D vaccine would be a vaccine administration fee, but your Part D plan can fully reimburse you for this fee.

Does Medicare Cover Flu Shots?

Getting an influenza vaccine is vital to preventing the seasonal flu. Medicare Part B will cover one flu shot per flu season. Many people only get a flu shot once per year, but Part B will cover two flu shots per year if they are spaced out to coincide with each flu season.

For example, the flu season typically runs from November into April. If you get a flu shot in January for that year’s flu season, you could get another shot towards the end of the year (October, November, December) for the following year’s flu season.

Does Medicare Cover Shingles Shots?

If you’ve ever had chicken pox as a child or at any other point in your life, you may be carrying a dormant version of the virus that causes shingles. Shingles is a painful and itchy rash. People typically begin to experience symptoms of Shingles as adults aged 50 or older.

The shingles vaccine is highly recommended if you’ve ever had chicken pox.  This vaccine is up to 97% effective in preventing shingles in those aged 50 to 69 and 91% effective in those aged 70 or older. The effectiveness of the shingles vaccine can last at least four years.

Find Medicare Plans in 3 Easy Steps

We have helped over 250,000 Medicare clients find their Medicare coverage

The only vaccine currently approved in the United States is Shingrix. It’s a two-dose vaccine that most people take two to six months apart. The shingles vaccine is covered under Medicare Part D.

Does Medicare Cover Tdap Vaccine?

The Tdap vaccine helps to prevent three dangerous diseases: tetanus, diphtheria, and pertussis (commonly known as whooping cough). A Tdap booster is highly recommended for adults of all ages every ten years.

The Tdap vaccine is fully covered under Medicare Part D.

Does Medicare Part D Cover Hepatitis A Vaccine?

Hepatitis kills roughly 1.4 million people every year, causing inflammation of the liver. Hepatitis A can cause severe and chronic liver damage.

Part D covers the Hepatitis A Vaccine when medically essential. The most common strains of this viral infection are hepatitis A, B, and C.

Medicare pays for a one-time screening test for the Hepatitis C strain. However, your doctor must order the screening, and you must meet certain conditions.

For coverage to apply, you must be at high risk due to a history of IV drug use.

Otherwise, if you had any blood transfusions before 1992 or if you were born between 1945 and 1965, you may qualify for Part D coverage.

Find Medicare Plans in 3 Easy Steps

We have helped over 250,000 Medicare clients find their Medicare coverage

Part D plans cover these vaccine costs. Beneficiaries without Part D may have to come out-of-pocket for treatment.

Does Medicare Cover the Pneumonia Vaccine?

Pneumonia is a potentially fatal viral infection that targets the lungs. A pneumonia vaccine can prevent this dangerous disease.

Pneumonia vaccines are covered under Medicare Part B. Part B actually covers two separate pneumonia vaccines taken in consecutive years. It covers the first shot if you’ve never gotten a pneumonia vaccine before, and then it will cover the second shot exactly one year after you received the first one.

Does Medicare Cover the RSV Vaccine?

In May 2023, the U.S. Food and Drug Administration (FDA) approved the first respiratory syncytial virus (RSV) vaccine for use in the United States. The vaccine is called Arexvy, and it’s designed to prevent lower respiratory disease caused by RSV in those aged 60 and older.

RSV is a seasonal and highly contagious virus that infects the lungs and breathing passageways. Like the flu, RSV circulation typically starts in the fall and peaks in the winter. Data from the CDC states that RSV leads to an estimated 60,000 to 120,000 hospitalizations and 6,000 to 10,000 deaths each year in the U.S. among older adults over the age of 60.

The RSV vaccine is also approved by the ACIP, so It is covered under Medicare Part D. The RSV vaccine is new, so some pharmacies and doctors may still be uninformed on whether it’s covered. If you have Medicare Part D and your health provider tries to charge you, call 1-800-MEDICARE (1-800-633-4227) for assistance. The RSV vaccine should be of no charge to you if you have a Medicare Part D plan.

If you have creditable non-Medicare drug coverage through your employer, the RSV vaccine may not be covered under your employer’s plan since it’s so new. Check with your plan to see if it’s covered before making an appointment.

Find Medicare Plans in 3 Easy Steps

We have helped over 250,000 Medicare clients find their Medicare coverage

How to Find a Medicare Plan to Cover Your Vaccines

We use a tool called the Part D plan finder to help determine all available plans in your area. Then, we compare rates and benefits for you.

Call us to get information on all the top carriers in the nation. Our licensed agents are ready to answer all your questions and walk you through the application.

Give us a call today at the number above and let us do the leg work. Or fill out a form online and get the process going today!

Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Medicare Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

2 thoughts on "What Vaccines Does Medicare Part B and Part D Cover?"

  1. I have the Choice plan. I had to pay for both my shingles shots at CVS and they want me to pay for my Tetanus shot. Is this right??? What about the flu shot?

    1. Your costs are determined by the plan you are enrolled in. Each plan has different copay and deductible amounts. As for the flu shot, it should be covered entirely by your plan.

Comment

Your email address will not be published. Required fields are marked *

string(3) "Yes"

5.0 Satisfaction Rating

It’s free and no obligation!

Find the Most Affordable Medicare Plans in your Area

X