Does Medicare Pay for a Tetanus Shot?

Medicare covers tetanus shots under specific circumstances. This federal health insurance program primarily serves individuals aged 65 or older, some younger people with disabilities, and those with End-Stage Renal Disease. Understanding how different Medicare parts cover vaccines clarifies the financial aspects of receiving a tetanus shot.

Tetanus Shots Under Medicare Part B

Medicare Part B covers medically necessary services and preventive care, including tetanus shots in certain situations. When a tetanus shot is needed due to an injury, such as a deep cut or wound, Part B typically covers it. This includes Td or Tdap shots administered in a doctor’s office or clinic for accidental exposure. Part B also covers certain preventive vaccines, like flu, pneumonia, and Hepatitis B, at 100% of the Medicare-approved amount from a participating provider. However, for routine boosters, coverage usually falls under Part D, unless directly related to treating an injury or exposure.

Tetanus Shots Under Medicare Part D

Medicare Part D, which includes prescription drug plans, covers tetanus shots not covered by Part B. This includes routine tetanus booster vaccines, such as Tdap (tetanus, diphtheria, and pertussis), often recommended every 10 years. Part D covers all adult vaccines recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP).

These vaccines are typically administered at a pharmacy or doctor’s office. Coverage, including deductibles and copayments, varies by the specific Part D plan. Many Part D plans cover these vaccines at no out-of-pocket cost, especially after January 2023.

Tetanus Shots Under Medicare Advantage

Medicare Advantage Plans (Part C) are private insurance plans approved by Medicare. They must provide at least the same level of coverage as Original Medicare (Parts A and B). If a tetanus shot is covered by Part B or Part D, it will also be covered by a Medicare Advantage plan. These plans often include prescription drug coverage (Part D) as part of their benefits.

Medicare Advantage plans may offer additional benefits beyond Original Medicare and often have different cost-sharing structures, provider networks, and procedures. Beneficiaries should review their plan documents or contact their provider to understand their exact coverage and any potential costs for a tetanus shot. These plans cannot charge more than Original Medicare for Part B-covered preventive services.

Your Out-of-Pocket Costs

Out-of-pocket costs for a tetanus shot vary by the Medicare part covering the service and circumstances. For preventive shots covered by Part B due to an injury or exposure, beneficiaries typically pay 20% of the Medicare-approved amount after meeting their Part B annual deductible. The vaccine itself may be covered at 100% if it falls under specific preventive guidelines, like flu or pneumonia shots.

For routine booster shots covered by Part D, costs depend on the plan’s formulary, deductible, copayment, and coverage phase. Since January 2023, many Part D plans cover ACIP-recommended adult vaccines, including tetanus, with no out-of-pocket costs. With a Medicare Advantage plan, costs also vary by plan and may include copayments or coinsurance for Part D-covered vaccines. Confirm costs with the provider and plan before receiving the shot.

How to Get Your Tetanus Shot

To receive a tetanus shot, beneficiaries should consult their primary care physician to determine the appropriate vaccine. They can also visit a local pharmacy, as many routine vaccines are administered there, or check their Medicare plan’s provider directory for in-network locations.

Confirm coverage details with your specific Medicare plan—Original Medicare, a Part D plan, or a Medicare Advantage plan—before getting the shot. Also verify with the provider’s office or pharmacy to understand any potential costs or network requirements. This proactive step helps ensure beneficiaries are aware of coverage and financial responsibilities.