Getting immunized against serious diseases can reduce your chance of serious illness and helps limit community transmission. But you may be wondering if Medicare covers all the vaccines you need. In fact, “Does Medicare cover the shingles vaccine?” and “Does Medicare cover flu shots?” are two common questions asked by beneficiaries. Let’s explore which immunizations are covered by Medicare.
Medicare Part A (Hospital Coverage)
Original Medicare is a federal government program that offers health insurance to seniors and other eligible individuals in two coverage areas, Part A and Part B. Medicare Part A, commonly referred to as hospitalization coverage, includes benefits for care in hospitals, skilled nursing facilities, hospice and home health. As part of your inpatient hospital care, you might receive shots or immunizations. Such vaccinations administered during a hospital stay are covered under Medicare Part B (or Part C if you obtain your Medicare benefits through private Medicare Advantage coverage instead).
Medicare Part B (Medical Coverage)
Medicare Part B – medical coverage – is the second portion of Original Medicare. Part B offers coverage for doctors’ visits, outpatient care, medical equipment and preventative services, such as immunizations. Some vaccinations are considered standard preventative care, while others may be covered under Part B due to an injury or for those who exhibit high risk factors.
Medicare Part B covers influenza (flu), pneumococcal (pneumonia) and COVID-19 vaccines. You may also receive coverage for vaccines such as rabies and tetanus related to the treatment of bite wounds and injuries.
Under Part B, you may receive coverage for Hepatitis B shots if you’re at intermediate or high risk. Some high-risk factors for Hepatitis B includes conditions such as: human immunodeficiency virus (HIV), End-Stage Renal Disease (ESRD), diabetes, hemophilia, sexually transmitted infections (STIs) and Hepatitis C.
Medicare Part C (Medicare Advantage)
Medicare Part C, also known as Medicare Advantage, is an alternative option to receive your Medicare benefits through private insurance companies. Part C typically bundles Part A, Part B and sometimes Part D (prescription drug coverage). For that reason, depending on the plan selected, it will cover the vaccinations list above in Part D, and it may also cover the shots listed in the next section under Part D. This is why it’s so important to speak with your provider about specific coverage for your chosen plan.
Medicare Part D
Part D is prescription drug coverage offered by private insurance companies either through a stand-alone plan or bundled with Medicare Advantage. Since this type of plan is provided by a private insurance company, immunization coverage can vary. The plan’s formulary (a list of covered prescription drugs and vaccines) will indicate what is covered. As a general rule, Medicare Part D coverage includes commercially available vaccines as well as ones deemed medically necessary to prevent illness.
The Centers for Medicare and Medicaid Services (CMS) requires Part D plans to cover the shingles vaccine (zoster). In general, Part D plans also cover commercially available vaccines such as Tdap (Tetanus, diphtheria and pertussis/ whooping cough) and MMR (Measles, mumps, rubella). Part D also covers immunizations when “reasonable and necessary” for those at high risk, including: Hepatitis A and Meningitis.
Here’s a chart to assist you in quickly referencing information about vaccination benefits by each Medicare coverage area.
|Vaccination Coverage by Medicare Plan Part|
|Vaccine List||Part B(medical insurance)||Part C*(Medicare Advantage)||Part D(prescription drug coverage)|
|Tdap (Tetanus, diphtheria and pertussis/ whooping cough)||N/A||Yes†||Yes|
|MMR (Measles, mumps, rubella)||N/A||Yes||Yes|
*Medicare Advantage plans bundle Parts A, B and sometimes D
†May be covered depending on Part C plan selection and whether or not that includes prescription drug coverage
‡Covered when “reasonable and necessary” or for those at higher risk
Consult with a Licensed Medicare Insurance Agent
If you ever have questions about what vaccinations or services are covered under your Medicare plan, reach out to a licensed Medicare insurance agent. Your plan of choice should include the optimal coverage you need, so it’s important to periodically reevaluate your options. Getting vaccinated and choosing a suitable Medicare plan can help preserve good health – let Medicare Portal assist you. We offer lifetime support for all your Medicare needs at no cost to you – contact us today!