Vaccinations are a key component of health care, and as such are an important element within Medicare coverage. However, not all vaccines are covered by Medicare Part B, so depending on your Medicare plan, you might end up paying out of pocket for some or all of a vaccine’s cost.
To help you identify which vaccines are covered, we’ve listed out important Medicare resources on the most common vaccines along with potential coverage and/or costs.
Annual Flu Shot
Flu shots are considered preventative treatment and therefore covered by Medicare Part B. Each Medicare beneficiary can receive one free flu shot per flu season.
Pneumococcal Vaccine
The pneumococcal vaccine is designed to prevent pneumococcal infections, such as certain types of pneumonia. Since the pneumococcal vaccine is also considered preventative, Medicare Part B covers one pneumococcal vaccination every 12 months in addition to a separate second vaccination if administered one or more years after the initial vaccination.
Your health care provider can determine if you need the initial vaccination or both.
Shingles Vaccine
The shingles vaccine is not covered by Medicare Part B because it is not considered preventive. To receive a shingles vaccine, you will be required to pay the entire cost.
However, if you have a Medicare Advantage plan or a Prescription Drug plan, the shingles vaccination is typically covered. Just know, you will still need to pay a copay or coinsurance.
Tdap Vaccine
Tdap vaccine is for tetanus, diphtheria, and pertussis (also known as whooping cough). Unless you’ve been exposed to tetanus, the Tdap vaccine is not considered preventative nor is it covered by Medicare Part B.
If you want the Tdap vaccine but have not been exposed to tetanus, you are required to pay the full cost of the vaccination (regardless of whether or not you have a Supplement or Medicare Advantage plan).
Hepatitis B
Hepatitis B shots may be covered by Medicare Part B if your doctor assesses you as a higher risk for Hepatitis B.
Diseases such as hemophilia, End-Stage Renal Disease, diabetes, and other factors may put you at a higher risk for Hepatitis B. However, if you do not have (or are not at risk for) these diseases, you are responsible for the vaccine’s full cost.
COVID-19
COVID-19 vaccines are considered preventative and fully covered for Medicare beneficiaries both in- and out-of-network.
Need Additional Medicare Resources and Support?
Medicare Choice Group is here to provide important Medicare resources and help you understand your individual Medicare coverage and benefits. To learn more about the vaccine coverage available to you or ask other related Medicare questions, reach out to our team of experts online or over the phone at (855) 482-0574.
