Does Medicare Cover the Measles Vaccine?

If you were born before the year 1957 when vaccination for measles began, you probably think you are naturally immune to measles now. Before the measles vaccine was created and children were regularly vaccinated, people gained immunity to measles only through exposure and illness. 

Medicare Benefits Solutions

Jan 16, 2021

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If you aren’t sure whether you had the measles when you were a child, or have no record of vaccination, you might not be immune, and you could still be susceptible to getting this illness. Recently, there has been a small resurgence in cases of measles in the United States due to some people not being vaccinated. Because of the return of measles in some communities, you might want to consider getting a measles vaccine even though you are an adult. If this is the case, you should have the information about whether your Medicare benefits cover the cost of your measles vaccination.

Do Medicare recipients have coverage for the measles vaccine?

If you have Original Medicare Part B, you have 100 percent coverage for certain vaccinations when they are administered by a health care provider that accepts Medicare assignment. These vaccines include yearly seasonal flu and H1N1 shots, a pneumococcal vaccine, and Hepatitis B shots if you are in a high-risk category.

Unfortunately, Medicare Part B doesn’t cover a measles shot. However, if you are one of the millions of Medicare recipients who have prescription drug coverage either through a stand-alone Part D plan or through a Medicare Advantage plan that includes drug coverage, you most likely do have coverage.

Today two vaccines can protect a person from getting measles. The first is the MMR vaccine which also protects against mumps and rubella. The second vaccine is the MMRV which protects against measles, mumps, rubella, and chickenpox. In most cases, health care providers prescribe the MMR vaccine for adults. 

Most Medicare prescription drug (Part D) plans and Medicare Advantage plans with prescription drug coverage include the MMR vaccine on their formularies. Check your plan’s formulary to ensure that an MMR vaccine is covered. If you don’t have a copy of the formulary, you can call a representative of your plan’s provider to get information. 

Through Part D or Part C Medicare benefits, the price of your vaccine depends on several factors. In many cases, your physician bills your prescription drug plan directly and you are responsible for the copay or coinsurance. In other instances, you might have to pay for your vaccine upfront and then submit a claim to get your reimbursement. Your cost depends on your plan’s copay amount and how it categorizes the MMR vaccine on the formulary.

If you have Medicare benefits through Part C, your provider might require that you get your vaccines and other prescription drugs from a pharmacy that is included in the plan’s network of providers. If you aren’t sure about the providers, you can check your written plan or speak to a representative of your plan’s provider.

What are measles?

Measles is a highly contagious virus that generally begins in the respiratory system. About 10 to 12 days after exposure, you might notice some of the following symptoms:

• Red rash all over the body 
• Coughing
• Fever
• Runny nose
• Red eyes
• White spots in the mouth
• Sore throat

For seniors, especially those who have a weakened immune system, catching the measles can cause serious and even life-threatening complications like ear infections, diarrhea, pneumonia, and encephalitis. 

If you or someone you are caring for is at risk for getting the measles and you aren’t sure if they had exposure or were vaccinated as a child, it’s a good idea to discuss your concerns with your health care provider. In many cases, even if you’ve had an MMR or MMVR, you may have lost your immunity and need a booster vaccine. If you have prescription drug coverage you probably have coverage for this valuable vaccine. 

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