Medicare is the federal health insurance program designed primarily for individuals aged 65 or older, as well as certain younger people with specific disabilities. Navigating the program’s structure can be complicated, particularly when trying to determine coverage for preventive health services like vaccines. Vaccine coverage is split between two main components: Medicare Part B (medical insurance) and Medicare Part D (prescription drug coverage). This division means the specific part of Medicare you have determines which vaccines are covered and what you may be required to pay.
Vaccines Covered Under Medicare Part B
Medicare Part B provides coverage for specific, highly recommended preventative vaccines that are often administered in a doctor’s office or clinic setting. The influenza, or flu, vaccine is covered annually, typically before or during the traditional flu season. Part B also covers the pneumococcal vaccines, which protect against pneumonia, and beneficiaries are generally eligible for two different shots given a year or more apart.
The COVID-19 vaccine, including updated versions and boosters, is covered under Part B as an essential preventive service. For these vaccines—flu, pneumonia, and COVID-19—beneficiaries typically pay nothing out-of-pocket, meaning there is no deductible or copayment when the vaccine is received from a provider who accepts Medicare assignment. This full coverage is intended to eliminate financial barriers to these commonly needed immunizations.
Coverage for the Hepatitis B vaccine is also provided under Part B, but it is conditional upon a person’s risk level. This vaccine is covered for individuals considered to be at medium or high risk for the virus, such as those with End-Stage Renal Disease, hemophilia, or diabetes. If a person is considered low-risk, the Hepatitis B vaccine would fall under Part D coverage instead.
Vaccines Covered Under Medicare Part D
Medicare Part D is the program’s prescription drug benefit, and it covers most vaccines that are not included under Part B, treating them like prescription medications. The primary vaccine covered by Part D is the Shingles vaccine, which is medically known as the Herpes Zoster vaccine. This vaccine is routinely recommended for adults aged 50 and older to protect against the painful rash and nerve complications of shingles.
Part D also covers other routine immunizations recommended by health authorities, such as the Tetanus, Diphtheria, and Pertussis (Tdap) vaccine. The Tdap vaccine, which prevents whooping cough, is covered when administered for routine prevention. Other vaccines, like the one for Respiratory Syncytial Virus (RSV), are also covered under Part D.
A significant change introduced by the Inflation Reduction Act of 2022 ensures that all adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are covered with no cost-sharing for Part D beneficiaries. This means that for ACIP-recommended vaccines like Shingles, Tdap, and RSV, you will not have a deductible, copayment, or coinsurance.
Financial Implications and Out-of-Pocket Costs
The out-of-pocket financial burden for Medicare-covered vaccines is highly dependent on which part of the program covers the immunization. For vaccines covered under Part B, which include the flu, pneumonia, and COVID-19 shots, the cost is typically zero for the patient. This cost-free structure for the most common preventive shots is designed to promote widespread immunization within the elderly population.
For the vaccines covered under Part D, such as the Shingles and Tdap shots, the elimination of cost-sharing for all ACIP-recommended vaccines means beneficiaries now also pay zero dollars. Before this policy change, Part D recipients often faced substantial copayments or had to meet their plan’s deductible before coverage began. These zero-cost provisions apply regardless of whether you have a standalone Part D plan or a Medicare Advantage Plan (Part C) that includes drug coverage.
Medicare Advantage Plans must provide at least the same vaccine coverage as Original Medicare (Parts A and B). However, these plans may offer additional benefits or different cost structures for non-ACIP recommended vaccines, so plan details can vary. Before receiving any vaccine, you should contact your Part D or Medicare Advantage plan directly to confirm the specific cost and ensure the administering pharmacy or provider is in your plan’s network to avoid unexpected bills.