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 recommended for babies, toddlers, adolescents, and teens, such as those for measles, mumps, and rubella.

However, there are also vaccines that are crucial for older adults, including those that prevent shingles as well as booster shots to ensure ongoing protection against diseases like tetanus.

Medicare recognizes this and covers many vaccines during adulthood. Not all vaccines are covered in part or in whole by Medicare, but those recommended by the Advisory Council on Immunization Practices (ACIP) are more likely to be.

1

COVID-19 Vaccines

COVID-19 vaccine

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In March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. In response, governmental, pharmaceutical, and biotechnology organizations took action worldwide in search of a vaccine.

By the end of 2020, two were granted emergency use authorization (EUA) by the Food and Drug Administration (FDA):

When the Coronavirus Aid, Relief, and Economic Security (CARES) Act was passed in March 2020, it directed that vaccines for COVID-19 would be covered for all Medicare beneficiaries. Not only that, there would be no cost-sharing for the vaccine or the vaccination.

This was a break from tradition, in that most vaccines are covered only when they are formally granted FDA approval rather than EUA.

Medicare recipients not only receive the COVID-19 vaccine for free, but the cost of the office visit is free of charge as well.

2

Hepatitis A and Hepatitis B Vaccines

woman with abdominal pain and hepatitis b
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Hepatitis A and hepatitis B are viruses that attack the liver. Hepatitis A is commonly transmitted through contaminated food. Exposure to hepatitis B typically occurs when you come in direct contact with the blood of an infected person.

More than 2.2 million Americans are living with chronic hepatitis B infection, while 80,000 are newly affected each year. The CDC also estimates that 24,000 people are newly infected with hepatitis A annually.

Because almost everyone recovers from hepatitis A without treatment, Medicare Part B does not cover hepatitis A vaccination. It also limits coverage of the hepatitis B vaccine to those considered to be at a high risk of infection or disease complications. These include people with:

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

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

3

Annual Flu Vaccine

Nurse giving older man a vaccine

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Influenza (flu) is a viral infection that affects tens of millions of people across the planet every year. It is a rapidly mutating virus and one that requires a new vaccine every year to counteract the waning effects of the previous year's vaccine.

In 2017, the Centers for Disease Control and Prevention (CDC) reported 6,515 flu-related deaths in the United States alone.

ACIP recommends that anyone over 6 months of age gets vaccinated against influenza every year. This is especially true for the elderly, people who are immunocompromised, or those with asthma, diabetes, or heart disease.

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 is a Medicare provider.

Choice of Flu Vaccine

The flu vaccine can be administered either as an intramuscular injection or as a nasal spray. Both are covered by Medicare.

Although the FluMist nasal spray vaccine was not recommended for the 2016-2017 and 2017-2018 flu seasons due to poor efficacy, ACIP approved it for the 2020-2021 flu season. 

In some cases, a high-dose flu vaccine may be offered to the elderly, which is also covered by Medicare.

4

Tetanus Vaccine

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 called Clostridium tetani that typically enter the body through breaks in the skin. It is not common in the United States but affects as many as one in 10 people worldwide.

Part of the reason tetanus is not common is due to widespread vaccinations in American children and adults. Tetanus shots are first given during childhood (typically as part of the DTaP or Tdap combination vaccines), while adults are encouraged to get booster shots every 10 years.

Medicare Part B pays 100% of the cost of a tetanus shot but only in specific cases. People with diabetic neuropathy, for example, often lack sensation in their feet. The shot is considered important for these individuals, as they may not realize that their foot has been contaminated.

In other cases, a person may sustain an animal bite or step on a nail and be given the shot afterward to protect against a potential infection.

Unless there is an injury or a demonstrated need for the vaccine, you may need to turn to Part D to see if the tetanus vaccine is covered.

Indications for Tdap Vaccination

In addition to the standalone tetanus shot, it is also recommended that you get at least one Tdap booster as an adult, which protects against tetanus, diphtheria, pertussis (whooping cough). It is also recommended during the third trimester of pregnancy.

However, the Tdap vaccine is currently not covered under the Part B benefit and may or may not be covered by your Medicare Advantage plan or Part D plan. Check your plan's formulary.

5

Pneumonococcal Vaccines

woman receives vaccine from her doctor
Pamela Moore / E+ / Getty Images

Pneumonia is a lung infection that can be caused by bacteria, viruses, and even fungi. Symptoms include fever, cough, and shortness of breath. According to the CDC, there were more than 257,000 emergency room visits for pneumonia in 2017 and more than 49,000 deaths.

The pneumococcal vaccine protects against potentially deadly bacteria called Streptococcus pneumoniae. Although one shot was recommended in the past for adults 65 and older, ACIP now recommends two different vaccines (Prevnar 13 and Pneumovax 23), each of which targets different pneumococcal serotypes. Medicare's Part B benefit covers both pneumococcal vaccines after the age of 65.

The Prevnar (PCV13) vaccine is given first, followed by the Pneumovax 23 (PPSV23) vaccine six to 12 months after.

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 have an underlying lung condition, such as COPD, that puts you at higher risk for pneumonia.

6

Shingles Vaccines

man with shingles pain
Terry Vine / Blended Images / Getty Images

Once you have chickenpox, the virus that causes it lives in your body forever. If you are lucky, it will never bother you again. However, for one in three people, the virus will reactivate at some point and cause shingles.

Although shingles is typically self-limiting, it can cause a long-lasting pain syndrome called post-herpetic neuralgia in as many as 10% to 15% of cases. If it occurs on the head near the eye or optic nerve, it can cause vision loss and even blindness.

There are now two vaccines for shingles approved in the United States:

Despite their high level of efficacy, the vaccines are costly and do not fall under the Medicare Part B umbrella. Certain Medicare Advantage plans or Part D plans cover one or both of the vaccines. Check your plan's drug formulary for details.

Vaccines Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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A Word From Verywell

Even if Medicare does not cover all of these vaccines for free, it may be in your best interest to get them anyway to protect yourself and adhere to the current ACIP recommendations. This is especially true as you get older and are more prone to disease complications.

If you don't know which vaccines you need, speak with your doctor, who can review your medical records and help you catch up.

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