Medicare Part B covers four main preventive vaccines at no cost to you: flu, pneumococcal (pneumonia), COVID-19, and Hepatitis B. It also covers certain vaccines given as treatment after an injury or exposure to disease, like tetanus and rabies shots. Everything else, including shingles and routine tetanus boosters, falls under Part D.
The Four Preventive Vaccines Part B Covers
Part B treats these four vaccines as statutory preventive benefits, which means they’re built directly into the program by law rather than handled through a prescription drug plan.
- Influenza (flu): Covered once per flu season. You can get your annual flu shot at your doctor’s office, a pharmacy, or other provider that accepts Medicare assignment.
- COVID-19: Part B covers FDA-approved and FDA-authorized COVID-19 vaccines, including the updated 2025–2026 formula from Moderna, Pfizer-BioNTech, or Novavax. Boosters are included.
- Pneumococcal (pneumonia): Part B covers the recommended pneumococcal vaccine sequence for adults 65 and older, as well as younger adults with certain medical conditions. The current recommendation is one dose of a pneumococcal conjugate vaccine (PCV21, PCV20, or PCV15). If you receive PCV15, a follow-up dose of PPSV23 is also covered, typically at least one year later.
- Hepatitis B: Covered for people at high or intermediate risk of infection.
For all four of these, you pay nothing out of pocket as long as your provider accepts Medicare assignment. No deductible, no coinsurance, no copay.
Vaccines Covered After an Injury or Exposure
Part B also covers certain vaccines when they’re medically necessary to treat an injury or direct exposure to a disease. The most common examples are tetanus and rabies. If you step on a rusty nail and need a tetanus shot in the emergency room, Part B covers it. If you’re bitten by an animal and need a rabies vaccination series, that’s also Part B.
The key distinction is the reason for the shot. A tetanus shot given because of a puncture wound is a Part B benefit. A routine tetanus booster you get every ten years to stay up to date is not. That preventive booster goes through Part D instead. Without an injury or direct exposure, Medicare Part B will not cover a tetanus immunization.
What Part B Doesn’t Cover
Several common adult vaccines are not Part B benefits. Shingles, RSV (respiratory syncytial virus), and the Tdap booster (tetanus, diphtheria, and pertussis) are all covered under Part D, not Part B. If you have a Medicare Advantage plan or a standalone Part D plan, those vaccines are handled through your drug benefit.
Before the Inflation Reduction Act took effect in January 2023, Part D vaccines could come with meaningful out-of-pocket costs. The law eliminated cost sharing and deductibles for all adult vaccines recommended by the CDC’s Advisory Committee on Immunization Practices when covered under Part D. In the first year alone, 10.3 million Part D enrollees received a recommended vaccine free of charge, saving more than $400 million in out-of-pocket costs collectively. So while Part D vaccines aren’t covered by Part B, you likely won’t pay anything for them either.
How the Pneumococcal Vaccine Schedule Works
The pneumococcal coverage can be confusing because the recommendations have changed over the years and may involve more than one shot. If you’re 65 or older and have never received a pneumococcal conjugate vaccine (or don’t know your vaccination history), Medicare Part B covers one dose of PCV21, PCV20, or PCV15. If your provider gives you PCV15, you’ll need a follow-up dose of PPSV23 at least one year later, which is also covered.
For people with weakened immune systems, cochlear implants, or cerebrospinal fluid leaks, the gap between PCV15 and PPSV23 can be shortened to as little as eight weeks because these groups face higher risk from certain strains of pneumococcal disease.
If you previously received only PPSV23 (the older pneumonia shot), you’re still eligible for a pneumococcal conjugate vaccine under Part B. The recommendation is to wait at least one year after your last PPSV23 dose before getting PCV21, PCV20, or PCV15. If you go with PCV15 in this situation, you don’t need another PPSV23.
How to Make Sure You Pay $0
The zero-cost guarantee for Part B preventive vaccines depends on one thing: your provider must accept Medicare assignment. Assignment means the provider agrees to bill Medicare directly and accept Medicare’s approved payment amount. Most doctors and pharmacies that serve Medicare patients do accept assignment, but it’s worth confirming before your appointment. If a provider doesn’t accept assignment, you could end up paying more than expected.
You don’t need to meet your annual Part B deductible before these vaccines are covered. They’re exempt from the deductible entirely. This applies to flu, COVID-19, pneumococcal, and Hepatitis B vaccines. For injury-related vaccines like tetanus after a wound, standard Part B cost-sharing rules may apply depending on the circumstances of the visit.