Dear Marci,
Does Medicare cover immunizations for things like the flu and tetanus? How much do they cost?
-Darwin (Omaha, NE)
Dear Darwin,
Medicare covers vaccines and immunizationswhen they are medically necessary. How they are covered and the cost sharing associated with them depends on the kind of immunization and your individual circumstances when you get it.
Most vaccines and immunizations are covered under the Medicare Part D prescription drug benefit. All Part D plans must include all commercially available vaccines on their formularies. If you need to get one of these immunizations, you should check with your Medicare Advantage Prescription Drug Plan or your standalone Part D plan to learn the coverage rules and find out what cost-sharing you will be responsible for.
Three immunizations are considered preventive services and are covered by Medicare Part B at 100% of the Medicare-approved amount. This means that if you meet the coverage requirements and receive these immunizations from the right kind of provider (a provider who accepts assignment if you have Original Medicare, or an in-network provider if you have a Medicare Advantage Plan), you will not have to pay any deductible, copay, or coinsurance. These immunizations are:
- Flu shot: Medicare Part B covers one flu shot every season. The flu season usually runs from November through April. Depending on when you choose to get your flu shot, Medicare may cover a flu shot twice in one calendar year. For example, if you got a shot in January 2018 for the 2017/2018 flu season, you could get another shot in December 2018 for the 2018/2019 flu season.
- Pneumonia shot: Medicare Part B covers two separate pneumonia shots. Currently there are two separate pneumonia vaccines available. Part B covers the first shot if you have never received Part B coverage for a pneumonia shot before. You are covered for a different, second vaccination one year after receiving the first shot. You are not required to provide a vaccination history when receiving the pneumonia vaccine. You can tell the health care professional administering the shot if/when you have received past shots.
- Hepatitis B shot: Medicare covers the hepatitis B vaccination if you are at medium or high risk for hepatitis B. Speak to your healthcare provider to see if you have any of the high- or medium- risk factors. For people who are at a low risk for hepatitis B, Medicare Part D covers the vaccine.
Some medically necessary vaccines are also covered by Medicare Part B with normal Medicare cost sharing, but only if you have been exposed to a dangerous virus or disease. For example, if a dog bites you, Medicare Part B will likely cover your rabies shot. In this case, you would be responsible for your Part B deductible (if applicable) and the 20% Part B coinsurance if you have Original Medicare. If you have a Medicare Advantage Plan, you would be responsible for your plan’s copay or coinsurance for this kind of service.
-Marci