What Vaccines are Covered by Medicare Part D?
A vaccine covered by Medicare Part D could save your life. According to the Centers for Disease Control and Prevention (CDC), vaccine-preventable diseases can cause long-term illness, hospitalization, and even death. Vaccines prepare the body to fight disease faster and more effectively so you don’t get sick according to the U.S. Department of Health & Human Services (HHS). Vaccines are made from very small amounts of weak or dead germs. The Centers for Disease Control and Prevention (CDC) recommends the following vaccines for adults 65 and older:
- Tdap or Td (tetanus, diphtheria, pertussis)
- Shingles (zoster)
- Pneumococcal (pneumonia)
- Chickenpox (if you did not get this vaccine as a child)
If you are traveling outside of the United States, your doctor might recommend vaccines for other diseases such as yellow fever, typhoid and/or rabies.
What vaccines does Medicare Part D cover?
Medicare Part D is prescription drug coverage for Medicare beneficiaries. Medicare Part D coverage is offered through private insurance companies through either a stand-alone Part D Prescription Drug Plan or a Medicare Advantage plan with prescription drug coverage.
According to the Department of Health and Human Services, Medicare Part D plans cover all vaccines that are:
- Commercially available
- Reasonable and necessary to prevent illness
- Not covered by Medicare Part B
While Medicare Part B generally covers most vaccines that Medicare patients need, Medicare Part D generally covers vaccines that Medicare Part B does not cover. This would include the shingles (zoster) vaccine. All Medicare Part D plans are required to cover the shingles vaccine and its administration.
To see if travel vaccines are covered by your Medicare Part D plan, check with the plan’s formulary, or list of covered drugs. A new preventative vaccine may not specifically appear in the Medicare Part D plan formulary but the plan may still cover the vaccine.
What vaccines does Medicare Part B cover?
Medicare Part B generally covers vaccines for:
One flu shot per flu season. You pay generally nothing if the provider accepts assignment for giving the shot.
- Hepatitis B
People at medium to high risk for Hepatitis B are covered. People at low risk may not be covered. You generally pay nothing if the provider accepts assignment for giving the shot.
- Pneumococcal to prevent pneumonia
All people with Medicare Part B are covered. You generally pay nothing if your provider accepts assignment for giving the shot.
What are the costs for Medicare Part D vaccines?
The fact that a vaccine is covered by Medicare Part D does not necessarily mean you pay nothing for this vaccine. What you pay for a Medicare Part D vaccine depends on:
- The type of vaccine
- Where you get the vaccine
- Who gives you the vaccine
In some cases, you may have to pay the entire cost for the vaccine medication and the administration of the vaccine and ask your Medicare Part D plan to pay you back for a share of the cost.
Do you have more questions about Medicare Part D coverage of vaccines? Feel free to enter your zip code on this page to browse Medicare plan options in your location. Or, if you prefer to get personalized assistance, contact us to speak with a licensed insurance agent. We can help you find Medicare plan options that address your Medicare needs.