These Are the Vaccines That Medicare Covers

What vaccines do you need and are they covered?

People tend to think of children when they think about vaccination. There is no question that certain vaccines are tailored to younger populations, such as those for the measles, mumps, polio, rubella and even human papillomavirus (HPV). However, vaccines are not only for the young. They can be used to prevent disease as we get older too.

Medicare recognizes this and covers vaccines in adulthood. It is important for you to know what vaccines are available to you, and why you may need them.


Medicare Coverage for the Flu Shot

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Influenza, aka the flu, is a viral infection that sickens tens of thousands of people across the world every year and sometimes more. Fever, chills, headache, cough, sore throat and muscle aches are hallmark signs of the disease though there is a wide spectrum of symptoms. Complications can vary from ear infections to pneumonia and, in the most severe cases, death. In 2017, the Centers for Disease Control and Prevention (CDC) reported 6,515 deaths in the United States from the flu.

The Advisory Committee on Immunization Practices recommends that anyone over six months of age is vaccinated against influenza. It is especially encouraged for people with asthma, diabetes, heart disease or anyone with a weakened immune system. Conditions like cancer and HIV fall into this category.

Accordingly, Medicare covers flu vaccination once every fall-winter season under its Part B benefit. The benefit will not cost you anything if your doctor has signed an agreement with Medicare.

The vaccine can be administered either as a shot or as a nasal spray, as an inactivated virus or as a live virus respectively. Based on reports that the nasal-spray version of the vaccine had not been adequately effective, the CDC Advisory Committee on Immunization Practices (ACIP) advised against that version of the vaccine during the 2016-2017 and 2017-2018 flu seasons. However, with improvements in efficacy, the nasal flu vaccination was again approved for the 2018-2019 flu season and now the 2019-2020 season. 

In some cases, a high-dose flu vaccine may be available to offer increased protection to the elderly. Medicare covers this vaccine as well. You can discuss the different options with your healthcare provider and decide which vaccine works best for your situation.


Medicare Coverage for the Pneumonia Shot

woman receives vaccine from her doctor
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Pneumonia is a lung infection that can be caused by bacteria, viruses, and even fungi. Symptoms may include fever, cough, shortness of breath, and low oxygen levels in the body. According to the Centers for Disease Control and Prevention, there were more than 257,000 emergency room evaluations for pneumonia in 2017 with more than 49,000 deaths.

It once was the case that getting a single pneumonia shot after 65 years old was enough to keep the most aggressive types of pneumonia at bay. Recommendations have since changed so that two different kinds of vaccinations are now recommended, PCV13 and PPSV23. Each vaccine targets different serotypes of pneumococcal pneumonia and together they optimize protection against the bacteria. Vaccinations have not been developed against the other causes of pneumonia.

Your Medicare Part B benefit covers both pneumococcal vaccines after age 65. The PCV13 is given first with the PPSV23 recommended six to 12 months after. The vaccine is free if your healthcare provider agrees to Medicare's Physician Fee Schedule. Keep in mind, however, that Medicare only pays for one dose of each vaccine. Any additional pneumonia shots, even at the recommendation of your doctor, will come at an additional cost. This is the case even if you are a patient with an underlying lung condition that puts you at higher risk for pneumonia.


Medicare Coverage for the Hepatitis A and Hepatitis B Shots

woman with abdominal pain and hepatitis b
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Hepatitis A and hepatitis B are viruses that attack the liver. The most common way that hepatitis A is transmitted is through ingestion of contaminated food. Exposure to hepatitis B occurs when you come in direct contact with the blood or other bodily fluids of an infected person. It is not enough, however, to simply touch the fluid to be infected. The fluid must enter the body. For example, the virus can be transmitted through blood transfusions, open wounds, sexual intercourse, and vaginal birth.

Hepatitis A is often a self-limited illness although symptoms can last several months in some cases. Hepatitis B can cause acute liver disease, cirrhosis, and even liver cancer (hepatocellular carcinoma). More than 2.2 million Americans are infected with hepatitis B and 80,000 are newly affected every year. The majority of people will clear the disease from their body while others live symptom-free with the disease on a chronic basis. Some people who have chronic hepatitis B will develop complications over time.

Medicare Part B does not cover Hepatitis A vaccination and limits coverage of Hepatitis B vaccination. It only covers it for those considered to be at risk for the disease. Examples of conditions that may increase your risk for hepatitis B include:

Health care workers, people in prisons and those who live in institutionalized facilities or group homes are also considered to be at higher risk for hepatitis B.

If your doctor agrees to terms set by Medicare, the hepatitis B vaccine series will be free to you under the Part B benefit. Talk with your healthcare provider to find out if you are a candidate for the three-shot series.

Even if you do not fall into these designated risk categories, Medicare Part D and possibly your Medicare Advantage plan may cover the hepatitis A or hepatitis B vaccine if they are considered medically necessary.


Medicare Coverage for the Shingles Shot

man with shingles pain
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Once you have chicken pox, the virus that causes it lives in your body forever. If you are one of the lucky ones, it will never bother you again. Unfortunately, for one in three people, the virus gets reactivated in the body. This typically occurs during times of stress or illness and can happen whether you are young or old. The painful, burning or itchy rash that develops on one side of your body is known as shingles.

Shingles, as uncomfortable as it can be, is often a self-limiting illness. As many as one in three people will devlop the condition in their lifetime. However, a long-lasting pain syndrome known as post-herpetic neuralgia can develop in as many as 10% to 15% of people. This complication can be debilitating in some cases and can decrease your quality of life. Keep in mind you can develop shingles more than once in your lifetime.

There are now two vaccinations for shingles, Shingrix and Zostavax, that have been shown to decrease outbreaks of the disease as well as the risk for postherpetic neuralgia when shingles does occur. Shingrix decreases your risk for shingles and postherpetic neuralgia by 90 percent and requires two doses two to six months apart. Zostavax only requires a single dose but is only 51 percent and 67 percent effective against shingles and neuralgia respectively.

The problem is cost. These vaccinations can be very pricey and do not fall under the Medicare Part B umbrella. Certain Medicare Advantage plans or Part D plans may cover the administration of these vaccines. Check out your plan to see if either of these vaccines is covered on your plan's drug formulary.


Medicare Coverage for the Tetanus (and Pertussis) Shot

tetanus pertussis vaccine
Medicare may cover tetanus vaccination after an injury. PM Images / DigitalVision / Getty Images

Tetanus, also referred to as lockjaw, is an infection caused by the bacteria Clostridium tetani. It is not a common disease in the United States but it affects as many as one in ten people worldwide. When the bacteria gets under your skin and into deep tissues, it causes muscle spasms and can even affect the muscles that control your breathing. In severe cases, it can be life-threatening.

The good news is that the disease is preventable with vaccination. A series of tetanus shots is recommended in childhood, and adults are encouraged to get boosters every 10 years.

Medicare Part B pays 100 percent of the cost of tetanus vaccination in specific cases. People with diabetes and/or neuropathy, for example, may not have good sensation on their feet and could have an open sore on the skin that increases their risk for tetanus. Other people may have injuries that lead to puncture wounds, for example, animal bites or stepping on a nail.

If you want to get the tetanus booster and have not had an illness or trauma, you will need to turn to your Medicare Advantage plan or Part D plan for coverage. There will likely be a charge for the vaccine depending on your plan's medication formulary.

Another consideration is protection against pertussis, aka whooping cough. Pertussis can be dangerous and even life-threatening for young children and those with weak immune systems. Vaccination against pertussis is only available when combined with the tetanus vaccine.

The Tdap (tetanus, diphtheria, and pertussis) shot is not covered under the Part B benefit and may or may not be covered by your Medicare Advantage plan or Part D plan. Please check with your plan's formulary.

It is recommended that you get at least one Tdap booster as an adult and consider additional vaccination to prevent spreading pertussis to at-risk individuals with whom you have close contact. All pregnant women are advised to get Tdap vaccination in the third trimester or immediately after delivery to protect their newborns.

Deciding Which Vaccines Are Right for You

No one has time to get sick. If you have Medicare, it may be in your best interest to protect yourself against diseases and consider these common vaccinations. However, there can sometimes be contraindications to using certain vaccines. Talk with your healthcare provider about which options may be best for you.

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Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. FastFacts: Influenza. National Center for Health Statistics. Updated May 30, 2019.

  2. ACIP votes down use of LAIV for 2016-2017 flu season. Centers for Disease Control and Prevention. Published June 22, 2016.

  3. AstraZeneca announces renewed recommendation and availability of FLUMIST QUADRIVALENT vaccine in the US. Astra Zeneca. Published February 21, 2018.

  4. AAP Updates Vaccine Recommendations for 2019-2020 Flu Season. American Academy of Pediatrics. Published March 14, 2019.

  5. FastFacts: Pneumonia. National Center for Health Statistics. Updated January 24, 2019.

  6. Hepatitis B Fast Facts. Hepatitis B Foundation. Updated 2018.

  7. Shingles Burden and Trends. Centers for Disease Control and Prevention. Updated July 1, 2019.

  8. Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Morb Mortal Wkly Rep 2018;67:103–108. doi:10.15585/mmwr.mm6703a5

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