Understanding Vaccines Covered by Medicare

Understanding Vaccines Covered by Medicare

By the GWAAR Legal Services Team (for reprint)

Vaccines are an important part of maintaining your health. Vaccines help to train our immune systems to fight and prevent disease. They also protect you and your loved ones from preventable diseases and illnesses. Vaccines are used to prevent and even treat exposure to diseases and illnesses. Vaccines aren’t only for children; they are given to adults and people of all ages. It’s also important to understand that vaccines are safe and have been used safely for over 100 years. They are important for people with normal immune systems and even more important for individuals with compromised immune systems. As important as they are, it can be difficult to understand how Medicare covers vaccines.

There are two parts of Medicare that cover vaccines. Supplemental Medical Insurance or Part B and Prescription Drug Coverage or Part D both cover different vaccines for different purposes. Understanding the difference can help you avoid coverage issues. Part B covers vaccines to treat injury or exposure. Part D covers vaccines to prevent illness. It’s important to understand why you need a vaccine to figure out which part of Medicare will cover the cost. Once you know which part of Medicare will cover the vaccine you can figure out your possible out-of-pocket cost.

Vaccines covered under Part B include vaccines for flu, pneumonia, hepatitis B, COVID, and in certain circumstances tetanus. These vaccines are covered to treat either an exposure to an illness or an injury. For example, if you step on a nail you would have the tetanus shot covered under Part B because the vaccine was administered to treat the injury caused by stepping on the nail. If you receive a vaccine covered under Part B you will not have a coinsurance or deductible.

Part D vaccines are covered for the prevention of illnesses. Most vaccines not covered under Part B fall under Part D coverage. Some examples would be vaccines for shingles, respiratory syncytial virus (RSV), and tetanus-diphtheria-pertussis (Tdap). Under Part D tetanus vaccines are covered if they are a booster or given unrelated to an injury. Vaccines listed in the Advisory Committee on Immunization Practices (ACIP) recommendations do not have an out-of-pocket cost even if it is administered by an out-of-network provider. If the vaccine is not on this list you will need to check with your Part D plan to see what your out-of-pocket costs will be.

Part B and Part D cover different vaccines for different purposes. In order to plan for out-of-pocket costs, you need to know which part of Medicare covers the vaccine you are looking to get. Remember Part B vaccines are given to treat injury or exposure to illnesses, while Part D vaccines are given to prevent illnesses. You can find more information about vaccines below.

Vaccine information:

· The Advisory Committee on Immunization Practices (ACIP) https://www.cdc.gov/acip-recs/hcp/vaccine-specific/

· If you don’t have Part D, SeniorCare covers some vaccines with no out-of-pocket costs. You can also contact one of ADRC of Waukesha County's  Benefit Specialists to help assist you enrolling in SeniorCare https://www.dhs.wisconsin.gov/seniorcare/vaccines.htm

· National Council on Aging vaccine information- https://www.ncoa.org/article/6-important-vaccines-for-seniors-covered-by-medicare/

· Medicare & You 2026-Has information about vaccines- https://www.medicare.gov/publications/10050-medicare-and-you.pdf  

-Aging and Disability Resource Center (ADRC) of Waukesha County