Does Medicare Cover the Hep A Vaccine?

Hepatitis A is a viral infection of the liver. This infection commonly spreads through consuming contaminated food or water, or close contact with an infected individual. While often a mild illness, Hepatitis A can lead to more serious complications for some individuals, particularly older adults or those with existing liver conditions. This article clarifies Medicare coverage for the Hepatitis A vaccine.

Medicare Coverage for the Hepatitis A Vaccine

Medicare covers the Hepatitis A vaccine, although the specific part of Medicare responsible for coverage depends on various circumstances. The vaccine is primarily covered under Medicare Part D, which pertains to prescription drug plans. Medicare requires all Part D plans to include the Hepatitis A vaccine on their formularies, as it is considered a preventive prescription drug. These plans are offered by private insurance companies and involve premiums, deductibles, and copayments or coinsurance, which can vary between plans.

Medicare Part D plans cover all adult vaccines recommended by the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP). Beneficiaries enrolled in a Part D plan will typically find their Hepatitis A vaccine covered.

In contrast, routine Hepatitis A vaccines are not covered under Medicare Part B. Part B primarily covers vaccines such as flu shots, pneumonia shots, and Hepatitis B vaccines for individuals at medium to high risk of infection. While Part B covers the administration of some vaccines, the Hepatitis A vaccine itself falls under the prescription drug benefit. In rare instances, if the Hepatitis A vaccine is administered during an inpatient hospital stay, Medicare Part A might cover the administration, or Part B might cover the administration if received in an outpatient setting, but the vaccine cost itself remains under Part D.

Medicare Advantage Plans are offered by private companies and must provide at least the same coverage as Original Medicare (Parts A and B). Most Medicare Advantage plans also integrate prescription drug coverage (Part D) into their benefits. Therefore, if a Medicare Advantage plan includes Part D coverage, it will cover the Hepatitis A vaccine through that integrated benefit.

Coverage for the Hepatitis A vaccine often depends on medical necessity, identified risk factors, or a physician’s recommendation. Individuals might be recommended for vaccination if they travel to areas with higher rates of Hepatitis A, have occupational exposure, suffer from chronic liver disease, or have close contact with an infected person. The vaccine is also recommended for those experiencing homelessness or individuals who use illicit drugs. These factors help determine the appropriateness of vaccination for an adult.

Understanding Costs and Accessing the Vaccine

When obtaining the Hepatitis A vaccine through a Medicare Part D plan, individuals encounter cost-sharing requirements. These can include deductibles, copayments, or coinsurance, which represent the portion of the cost paid by the beneficiary. Before 2023, the Hepatitis A vaccine under Part D had costs.

However, the Inflation Reduction Act of 2022 changed vaccine coverage under Medicare Part D. As of January 1, 2023, this law eliminated out-of-pocket costs for all adult vaccines recommended by the ACIP, including the Hepatitis A vaccine. This means beneficiaries with Part D coverage should not have a copayment or deductible for the Hepatitis A vaccine.

To receive the Hepatitis A vaccine, the first step involves consulting with a healthcare provider to determine if the vaccine is appropriate. The provider can assess risk factors and medical history to make a recommendation. Once recommended, the vaccine can be obtained at a doctor’s office or a local pharmacy.

When getting vaccinated, present both your Medicare card and your prescription drug plan ID card. Before receiving the vaccine, directly contacting your specific Medicare Part D plan or Medicare Advantage plan is recommended to confirm coverage details. Inquire about whether the Hepatitis A vaccine is covered, and verify that there will be no out-of-pocket cost as per current regulations. You may also ask if there are any specific pharmacies or providers that are preferred by your plan for vaccinations. For additional assistance with Medicare questions, resources like Medicare.gov or State Health Insurance Assistance Programs (SHIP) can provide further guidance.