Does Medicare Cover Vaccines?
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Vaccine Coverage Under Medicare
Getting vaccinated is one of the most important things you can do for your health. Vaccines are your first line of defense against getting sick and spreading that illness to family, friends and others around you.
Fortunately, Medicare can cover most vaccines at no out-of-pocket cost to you. But to get full coverage, you must have Medicare Part B and a Part D Medicare Prescription Drug Plan.
Medicare Part D is the prescription drug benefit. You get Part D either by enrolling in a standalone Part D drug plan or by having a Medicare Advantage plan that includes drug coverage.
Medicare Part B vs. Medicare Part D: How Is Vaccine Coverage Decided?
Vaccine coverage falls under two parts of Medicare: Parts B and D.
Part B is part of what is known as Original Medicare. It covers doctor visits and outpatient care, including a few vaccines.
Part D covers prescription drugs. Part D Medicare Prescription Drug plans are sold by private insurance companies approved by Medicare, like HealthSpring.
Part D covers all adult vaccines recommended by the federal Advisory Committee on Immunization Practices (ACIP), except for those covered by Part B.
Here’s how Medicare divides vaccine coverage between Parts B and D:
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Part B
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Part D
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How Much Do I Pay for Vaccines Under Medicare?
Vaccines under Medicare Parts B and D can come at no cost to you. That means no copays, no deductibles and no administration fees.
Under the Inflation Reduction Act (IRA) of 2022, out-of-pocket fees were eliminated for many vaccines in Part D beginning in 2023. The vaccines covered under the IRA include adult vaccines recommended by ACIP. Your plan may include additional vaccines on their formulary (drug list). In that case, the vaccines are part of your coverage, but you might be charged a copay or co-insurance. Covered vaccines must be delivered by an in-network provider or pharmacy.
You won’t pay anything for a Part B vaccine if you go to a doctor, provider or pharmacy who accepts Medicare.
Why Isn’t My Provider’s Office Giving Me My Vaccines?
Vaccine administration in your provider’s office may be out-of-network if they do not accept and contract under Medicare Part B, or if they do not have a separate agreement with your Medicare Part D plan.
Providers who accept Part B must have separate agreements with individual Medicare Part D plans to be considered in-network.
Your provider’s office may refer you to a pharmacy or facility that accepts Part D. If your provider offers to administer your vaccine, ask them if they are considered in- or out-of-network for Part D vaccinations.
Frequently Asked Questions
Does Medicare cover the pneumonia shot?
Yes.
The pneumonia shot is covered at no out-of-pocket cost to you under Medicare Part B. So you pay no copay or deductible under a traditional Medicare plan. The pneumonia shot is not covered under Medicare Part D.
Does Medicare cover the flu shot?
Yes.
Medicare covers one annual seasonal flu shot. It is covered at no out-of-pocket cost to you under Part B, with no copay or deductible under a traditional Medicare plan. The flu shot is not covered under Medicare Part D.
Does Medicare cover the shingles shot?
Yes, if you have a Part D Prescription Drug Plan. If you have such a plan, either in addition to traditional Medicare or as part of your Medicare Advantage plan, the shingles vaccine (Shingrix) is covered. Older adults are at a higher risk of severe shingles, which is why the CDC highly recommends adults 50 and older receive a vaccine to protect against shingles and its complications.
Medicare Part B does not cover Shringrix or other shingles vaccines.
Shingrix is the recommended shingles vaccine. It’s given as a two-dose series, with the shots 2 to 6 months apart. It helps prevent shingles, a painful rash caused by reactivation of the chickenpox virus.
Does Medicare cover the Respiratory Syncytial Virus (RSV) shot?
Yes, if you have a Part D Prescription Drug Plan, either in addition to traditional Medicare, or as part of your Medicare Advantage plan. Medicare Part B does not cover the RSV vaccine.
I don’t have Medicare Part D. Can I get vaccinated?
Yes.
You are free to receive whichever vaccines your provider agrees are appropriate for your age and health. However, if you don’t have a Medicare Part D plan, you will be responsible for any costs associated with your vaccines that are not available under Medicare Part B.
Does Medicare require vaccines?
No.
Medicare is a health insurance plan. It isn’t a mandate for your care. You are free to make decisions about your vaccines or any other recommendations from your health professionals.
Why are Medicare vaccines covered two different ways?
Medicare originally had no outpatient drug coverage when it became law in 1965. Adding coverage only comes through Congress.
Part B vaccine coverage grew from a determination that the pneumonia, hepatitis B (in certain cases), flu and COVID-19 shots were critically important to public health, especially for high-risk populations. They are considered tools to treat patients for injury or illness, or immediate risk of injury or illness.
Part D vaccine coverage focuses on preventive coverage. Those vaccines are also considered important, but not a tool to treat injury or illness, or immediate risk of injury of illness.
How does Medicare decide what vaccines to cover?
The vaccines Medicare covers under Parts B and D, for a $0 copay, are those recommended by the Advisory Committee on Immunization Practices (ACIP).
ACIP is part of the federal Centers for Disease Control and Prevention (CDC). ACIP is responsible for advising the CDC on how vaccines are used in the United States, including dosages and schedules.
Some Part D plans might cover vaccines not on the ACIP list. However, those are not required to be administered with no out-of-pocket costs.