Does Medicare Part D Cover Vaccines?
Vaccines are an important part of preventative healthcare for seniors. In answer to the question “does Medicare Part D cover vaccines” the answer is yes. Medicare covers most of the recommended vaccines for seniors. However, depending on the vaccine, the costs can be covered under different parts of Medicare. Keep reading to find out how vaccine coverage works with Medicare and whether or not you are covered.
Medicare Part D Vaccine Coverage
Medicare Part D is the part of Medicare that covers prescription drugs. Private insurance companies offer Part D as a stand-alone plan. Medicare Part D works alongside Original Medicare (Part A and Part B) to help cover some of the costs of prescription drugs, including vaccinations. In general, Medicare Part D vaccine coverage includes all vaccines that are not covered under Medicare Part B. According to Medicare.gov, Medicare Part D plans cover all vaccines that are:
- Commercially available
- Reasonable and necessary to prevent illness
- Not covered by Medicare Part B
The following vaccines are generally covered under Medicare Part D:
- Tdap vaccine (tetanus, diphtheria, and pertussis)
- Shingles vaccine (zoster)
- MMR vaccine (measles, mumps, and rubella)
Medicare Part B Vaccine Coverage
Medicare Part B, also known as “Medical Insurance”, is the part of Medicare that covers most medical costs including some vaccines. Vaccines covered under Medicare Part B include:
- Hepatitis B vaccine (medium to high-risk patients)
- Influenza (flu) vaccine
- Pneumococcal (pneumonia) vaccine
- Vaccines used for the treatment of an injury (tetanus, rabies)
- Vaccines used to reduce your risk for exposure to a condition or disease (COVID-19)
All other vaccines are covered under Medicare Part D.
What are the Costs for Medicare Part D Vaccines?
How much you pay for vaccines under Medicare Part D depends on a few factors such as:
- The type of vaccine you receive
- Where you get the vaccine
- Who administers the vaccine
Generally, you will pay the least amount for vaccines when they are administered at in-network pharmacies or a doctor’s office. Most individuals will only need to pay their plans copay or coinsurance amount. In some cases, when the vaccine is given at a doctor’s office you may need the provider to coordinate with your Part D plan to see if the vaccine costs can be billed directly to your plan. If not, you may need to pay out-of-pocket for the cost of vaccination and request reimbursement from your Part D plan provider. In any case, it is best to check your plan’s coverage rules before receiving a vaccination.
What Vaccines are Recommended for Adults 65 Years or Older?
The Centers for Disease Control and Prevention (CDC) recommends adults 65 years of age or older receive the following vaccinations:
- Tdap or Td (tetanus, diphtheria, pertussis)
- Shingles (zoster)
- Pneumococcal (pneumonia)
- Chickenpox (if you did not get this vaccine as a child)
Part D Enrollment
Enrollment in Medicare Part D is not required however, it is beneficial for those who rely on necessary medications and vaccinations. It is important to enroll in prescription drug coverage when you’re first eligible (during your Initial Enrollment Period) in order to avoid a costly late enrollment penalty. The late enrollment penalty is a permanent fee that is added to your monthly Part D premium once you enroll in prescription drug coverage. The fee remains in place the entire time you are enrolled in a Medicare prescription drug plan. For more information about when to enroll in Medicare Part D coverage, visit: “When Can I Enroll in Medicare Part D?”