Medicare Part D covers all commercially available vaccines that are reasonable and necessary to prevent illness, with one exception: vaccines already covered under Medicare Part B. Since January 1, 2023, thanks to the Inflation Reduction Act, Part D enrollees pay nothing out of pocket for any adult vaccine recommended by the Advisory Committee on Immunization Practices (ACIP), the federal body that sets the U.S. immunization schedule.
Vaccines Covered Under Part D
Rather than listing specific vaccines by name, Part D uses a broad rule: if a vaccine is commercially available, recommended to prevent illness, and not already covered by Part B, it falls under Part D. In practice, the most common Part D vaccines include:
- Shingles (Shingrix)
- RSV (respiratory syncytial virus)
- Tdap (tetanus, diphtheria, and whooping cough)
- Measles, mumps, and rubella (MMR)
- Chickenpox (varicella)
- Hepatitis A and Hepatitis B
- HPV (human papillomavirus, for eligible adults)
This list isn’t exhaustive. Because the rule is based on ACIP recommendations rather than a fixed list, newly approved vaccines get picked up automatically once ACIP adds them to its schedule. The RSV vaccine, for example, became available in 2023 and was immediately covered at no cost under Part D.
What Part B Covers Instead
A handful of vaccines are carved out of Part D because Medicare Part B already pays for them. These include the annual flu shot, pneumococcal (pneumonia) vaccines, COVID-19 vaccines, and the hepatitis B vaccine when given to people at medium or high risk. If you’re getting one of those, it’s billed through Part B, not your drug plan. The practical difference for most people is small since Part B also covers these at no cost, but it matters if you only have Part D coverage through a standalone prescription drug plan.
What You Pay
For any ACIP-recommended vaccine, your Part D plan charges no copayment and applies no deductible. This is true even if you get the shot from an out-of-network provider, such as a pharmacy or clinic not in your plan’s network. Before 2023, Part D enrollees sometimes faced significant out-of-pocket costs for vaccines like the shingles shot, which can retail for over $200 per dose. The Inflation Reduction Act eliminated that cost sharing entirely for recommended vaccines.
Most prescribed vaccines are ACIP-recommended, so most people will pay nothing. However, if your doctor prescribes a vaccine that falls outside ACIP recommendations, your Part D plan can charge coinsurance or a copayment. This is most likely to come up with travel vaccines like yellow fever, typhoid, or Japanese encephalitis, which are not part of the routine adult immunization schedule. Part D still covers these vaccines, but you may owe a share of the cost.
Where to Get Part D Vaccines
You can get Part D vaccines at a retail pharmacy, your doctor’s office, or other clinical settings. Pharmacies are often the simplest option because they can bill your Part D plan directly at the time of your visit. If you receive a Part D vaccine at a doctor’s office, the billing process can be slightly more involved since medical offices typically bill through Part B. In some cases, you may need to pay upfront and submit a claim to your Part D plan for reimbursement.
If you have a Medicare Advantage plan, check whether it includes drug coverage (most do). Only Medicare Advantage plans that include Part D drug benefits will cover these vaccines. Original Medicare alone, without a standalone Part D plan, does not cover Part D vaccines.
Shingles and RSV: Two Worth Knowing About
The shingles vaccine is one of the most commonly searched Part D vaccines because it’s recommended for all adults 50 and older and requires two doses. It protects against the varicella-zoster virus, which causes a painful skin rash that can lead to lasting nerve pain. Under Part D, both doses are covered at zero cost.
The RSV vaccine is newer and recommended for adults 60 and older, as well as pregnant individuals during certain weeks of pregnancy. RSV can cause serious respiratory illness in older adults, and the vaccine is a single dose. Like the shingles vaccine, Part D covers it with no copayment or deductible.