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Medicare - Vaccine Coverage




One of the most important roles of Medicare in keeping people healthy is the coverage of preventive services.  Preventive services include Vaccines, which is the primary key to avoiding diseases and to prevent you from aging well. Lucky to say that Medicare now helps pay for four vaccines, each of which you should discuss with your doctor to protect yourself. 

Influenza Vaccine

The flu or influenza is a contagious respiratory disease that can be severe and life-threatening. Older adults, even those who are healthy, are at higher risk when it comes to the flu due to age-related weakening of their immune systems which makes it more difficult for them to fight off disease. In 86% of adults, 65+ are managing a chronic condition like diabetes or heart disease, with this, the flu can be even more dangerous because they are more likely to develop complications or become hospitalized. According to the CDC, the best way to prevent the flu is through a flu vaccine. In an aging population wherein the risk is much higher, a higher-dose version of the flu vaccine was created specifically for them (talk to your doctor today about this option).

Flu vaccine coverage

The flu vaccine is once a year, cost-free Medicare B benefit. For Original Medicare, you must use a physician or healthcare provider who accepts Medicare assignment, and for Medicare Advantage, you may have to use an in-network doctor or pharmacy.


Shingles Vaccine

Shingles is a painful skin rash caused by the same virus responsible for chickenpox. Shingles are less contagious than chickenpox and can only be passed on to another person up until the point when the infected person’s blisters begin to scab.

Researchers believe that the age-related weakening of our immune systems can trigger the “reawakening” of the dormant chickenpox virus. The majority of adults are 60 years or older and the older you are when you get shingles, the more likely you are to have severe side effects, like fever, exhaustion, and loss of appetite. These can lead to malnutrition, physical deterioration, and/or additional infections.


Shingles vaccine coverage

All Medicare Part D drug plans, or Medicare Advantage plans that include prescription coverage, typically cover the shingles vaccine. But, there is usually an out-of-pocket cost and usually would depend on your plan, either you will be responsible for a copayment (a fixed dollar amount) or coinsurance (percentage of the vaccine’s cost). You are likely to have the least out-of-pocket expenses if you use a pharmacy in your plan’s network. Each plan has specific rules for covering the vaccine itself, as well as the administration of the injection, so it’s best to contact your insurance company directly to find out your specific out-of-pocket cost, and any rules you must follow regarding where you receive the vaccine.


Pneumococcal Vaccine

Pneumococcal disease causes severe infections throughout the bloodstream and/or key organs. Conditions that result from this disease include pneumonia (infection of the lungs), meningitis (infection of the lining of the brain and spinal cord), and bacteremia (infection of the bloodstream). It can also result in deafness, brain damage, loss of limbs, and even death.

Pneumococcal disease kills 18,000 adults 65+ each year. A weakening immune system means that older adults are at greater risk, and can face more severe side effects, especially those who are managing chronic diseases.

Pneumococcal Vaccine Coverage

The pneumococcal vaccine is a cost-free benefit covered by Medicare Part B. For Original Medicare, you must use a physician or healthcare provider who accepts Medicare assignment, and for Medicare Advantage, you may have to use an in-network doctor or pharmacy.


Hepatitis B Vaccine

Hepatitis B (or hep B) is a contagious virus that infects the liver. Acute hep B, which usually lasts a few weeks, often mimics symptoms similar to the flu, like fever and nausea. Chronic hep B is long-term, often has no symptoms at all, and can cause liver damage or death.


The liver and its function change as you age, making hep B more prevalent among older adults. Your risk of contracting hepatitis B increases if you have hemophilia, end-stage renal disease (ESRD), diabetes, or other conditions that lower resistance to infection. Acute hep B is particularly dangerous for older adults because there is no specific treatment for the symptoms.


Hepatitis B Vaccine Coverage

Medicare Part B insurance covers the full cost of the hep B vaccine(s) if a doctor determines that you are at high or medium risk of contracting the hep B virus, and the physician or healthcare provider administering the vaccine accepts Medicare assignment. Consult your doctor to determine your risk of getting hep B.


Make the most of your Medicare coverage

Getting these vaccines is an important part of healthy aging, and they also help ensure the health of your friends and family. Call your doctor today to see if these vaccines are right for your health, and then check with your Medicare provider about where you can get them and what is your expected out of pocket cost. If you know someone who may not be vaccinated, share this information with them so they can take the next step toward protecting themselves.
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