What Vaccines are Covered by Medicare?
Medicare Benefits Solutions
May 5, 2021
Immunizations are vital to prevent individual illness and the spread of disease. As a Medicare recipient, you need to know where to look for information on Medicare benefits as some vaccines are covered under Part D (prescription drug plan) and others under Part B (medical insurance).
Part D vaccines
Most recommended and commercially available immunizations are covered under Part D. This includes the vaccine for tetanus, diphtheria and pertussis, which is administered in the form of a booster shot for adults and adolescents. For children, the shot is called DTaP. Pertussis is also known as whooping cough. The shingles (herpes zoster) vaccine is covered under Part D as well. To check for other vaccines covered under Part D, review your plan’s formulary.
A formulary is also known as a drug list. Beneficiaries enroll in Medicare-approved drug plans from private insurance companies either as a stand-alone drug plan or as part of a Medicare Advantage plan. If you have trouble finding your formulary, check with your plan administrator. Most plans provide online access.
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Part B vaccines
Part B covers the vaccines for:
- Influenza, one shot per season
- Hepatitis B, applicable if you are at medium-to-high risk
- Pneumococcal, which includes two shots if needed and if the second shot is administered at least one year from the date of the first shot
- COVID-19, including drugs released under Emergency Use Authorization (EUA), which are pending FDA-approval
The cost of drugs under Part D varies by the plan. The formulary consists of tiers, which reflect the cost. For example, your drug list may have five tiers ranging from generic on the lowest tier to specialty drugs on the highest tier with corresponding costs. Check your Summary of Benefits for copayments associated with each tier.
You pay nothing for FDA-approved COVID-19 vaccinations. Remember to have your Medicare card with you to present to the provider who will then bill Medicare directly.
For the other immunizations covered by Part B Medicare benefits, you pay nothing as long as your health care practitioner accepts assignment for administering the vaccines. By accepting assignment, your provider has agreed to accept the Medicare-approved payment directly from Medicare.
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