Is the Hepatitis A Vaccine Covered by Medicare?

Hepatitis A is a liver infection caused by a virus, commonly transmitted through contaminated food, water, or close contact. It can lead to severe health issues, making prevention important. Medicare, the federal health insurance program for individuals aged 65 or older and certain younger people with disabilities, covers various medical services, including immunizations.

Coverage Under Medicare Part D

Medicare Part D prescription drug plans typically cover the Hepatitis A vaccine. These plans are offered by private insurance companies approved by Medicare. All Part D plans are required to include the Hepatitis A vaccine on their formularies.

Part D generally covers most commercially available vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), unless specifically covered under Medicare Part B. While plan formularies can vary, beneficiaries should review their specific plan’s drug list to confirm coverage details.

A significant change introduced by the Inflation Reduction Act of 2022 means that, as of January 1, 2023, beneficiaries enrolled in a Part D plan pay no out-of-pocket costs for ACIP-recommended vaccines, including the Hepatitis A vaccine. This eliminates deductibles, copayments, and coinsurance for these covered immunizations.

Coverage Through Medicare Advantage Plans

Medicare Advantage Plans, also known as Part C, are offered by private insurance companies as an alternative to Original Medicare. These plans are mandated to provide at least the same level of coverage. Many Medicare Advantage plans integrate prescription drug coverage, often referred to as MA-PD plans.

When a Medicare Advantage plan includes prescription drug benefits, it will cover vaccines, such as the Hepatitis A vaccine, similar to a standalone Part D plan. Specific terms, conditions, and network requirements for vaccine coverage are determined by the individual plan.

Understanding Costs and Access

Beneficiaries with Medicare Part D or a Medicare Advantage plan that includes prescription drug coverage will have no out-of-pocket costs for the Hepatitis A vaccine. This zero cost-sharing for ACIP-recommended vaccines, including Hepatitis A, became effective in 2023 due to federal legislation, covering both the vaccine and its administration.

The Hepatitis A vaccine can typically be administered in a doctor’s office or a pharmacy. Beneficiaries should verify coverage details and network requirements with their plan or healthcare provider before receiving the vaccine.