It’s important to maintain your health by receiving vaccinations as directed by your doctor. As you consider your doctor’s recommendations, be mindful that not all vaccines are covered by Medicare Part B, only those that are considered preventive.
Depending on your Medicare plan, you may be responsible for all or a portion of a vaccine’s cost. As a result of the Inflation Reduction Act of 2022 going into effect, individuals with Part D drug coverage will pay little or nothing out-of-pocket for adult vaccinations recommended by the Advisory Committee on Immunization Practices.
If you’ve ever wondered, “Does Medicare cover this vaccine?” our team is here to help clarify that for you. Keep this information in mind to ensure you’re aware of the potential costs associated with your next vaccine.
Since a flu vaccine is considered preventive, Medicare Part B covers one flu vaccination per flu season. As a Medicare beneficiary, you will not pay anything to receive your flu shot.
A pneumococcal vaccine is also considered preventive, as it’s designed to prevent pneumococcal infections, such as certain types of pneumonia.
Part B covers one pneumococcal vaccination per 12 months, as well as a separate, second vaccination if administered one year or more after the initial vaccination. If your health care provider recommends this vaccine, he or she will be able to determine if you need the initial vaccination or both.
A shingles vaccine is not classified as preventive and is not covered by Medicare Part B. If you are enrolled in a Medicare Advantage plan or prescription drug plan, however, a shingles vaccination is usually covered, but you may still have to pay a copay or coinsurance for it.
If you aren’t enrolled in Medicare Advantage or prescription drug plan, you’ll be required to pay for the entire cost of the shingles vaccine.
Tdap is the vaccine for tetanus, diphtheria, and pertussis (also known as whooping cough). Tdap is not considered preventive and is not covered by Part B unless you’ve been directly exposed to tetanus.
If you haven’t been exposed to tetanus but want to receive the Tdap vaccine and you have a Supplement or Medicare Advantage plan, you may be able to get the vaccine at no cost.
Hepatitis B is a virus that can infect the liver. Medicare Part B may cover your Hepatitis B shot if you have a higher risk for Hepatitis B, which you can discuss with your doctor. Diseases such as hemophilia, diabetes, End-Stage Renal Disease, and other factors may put you at a higher risk for Hepatitis B. If you don’t have or aren’t at an increased risk for these diseases, you’ll pay for the vaccine out of pocket.
The COVID-19 vaccines and booster shots are fully covered for all Medicare beneficiaries, as they are considered preventive. No matter what Medicare plan type you have, you won’t pay a deductible or copayment, and your provider cannot charge you an administration fee for the shot.
When it comes to Medicare, it’s important to be in the know on costs and coverage. If you’re new to RetireMed and would like trusted guidance on your health coverage, contact our advisors at 937.915.3563 or schedule a call at your convenience.
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