Which Vaccines Does Medicare Cover?

Medicare provides coverage for various preventive services, including vaccinations. These immunizations are a fundamental component of maintaining well-being, helping to protect individuals from a range of infectious diseases. By covering these preventive measures, Medicare assists its beneficiaries in proactively managing their health and reducing the risk of illness, promoting overall health outcomes for older adults and those with certain disabilities.

Vaccines Covered Under Medicare Part B

Medicare Part B covers specific vaccines considered preventive services. These are typically administered in a doctor’s office, clinic, or at pharmacies that accept Medicare assignment. Beneficiaries usually pay nothing for these immunizations, provided their healthcare provider accepts Medicare’s approved payment amount.

The influenza (flu) vaccine is covered annually under Medicare Part B. This coverage is important for older adults, who face a higher risk of severe complications from the flu, such as pneumonia. Medicare Part B covers all flu shots for individuals aged 65 and older, including high-dose and adjuvanted options.

Pneumonia vaccines are also covered by Medicare Part B, helping to protect against pneumococcal disease. Medicare generally covers two types of pneumonia shots: a first dose available at any time, and a second dose covered if administered at least one year after the first. For most individuals aged 65 and older, specific vaccine types like PCV20 or a two-dose regimen of PCV15 followed by PPSV23 are recommended.

Hepatitis B vaccines are covered by Medicare Part B for individuals at medium or high risk of contracting the virus. Risk factors include end-stage renal disease, hemophilia, living with a hepatitis B carrier, or being a healthcare professional with frequent blood contact. As of January 1, 2025, Part B expanded coverage for the hepatitis B vaccine, removing the physician’s order requirement and revising the “intermediate risk” definition. COVID-19 vaccines are also covered under Medicare Part B, with updated formulations available for eligible individuals.

Vaccines Covered Under Medicare Part D

Medicare Part D provides prescription drug coverage and generally covers routine vaccines not covered under Part B. This coverage is typically obtained through a stand-alone prescription drug plan or as part of a Medicare Advantage (Part C) plan that includes drug coverage. Part D plans are required to cover all commercially available vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), unless already covered by Part B.

The shingles vaccine (zoster vaccine) is covered under Medicare Part D. It is typically administered as a two-shot series and helps prevent the painful rash associated with the virus. As of January 1, 2023, due to changes from the Inflation Reduction Act, beneficiaries with Part D coverage generally face no out-of-pocket costs for the shingles vaccine.

The tetanus, diphtheria, and pertussis (Tdap) vaccine is covered by Medicare Part D. This vaccine protects against whooping cough. Similar to the shingles vaccine, the Tdap vaccine typically has no out-of-pocket costs for beneficiaries with Part D coverage since January 2023. Other vaccines, such as Respiratory Syncytial Virus (RSV) vaccine, Hepatitis A, and certain Hepatitis B vaccines for low-risk individuals, are also covered under Part D.

Understanding Vaccine Costs with Medicare

The cost-sharing for vaccines under Medicare varies depending on whether they are covered by Part B or Part D. For vaccines covered under Medicare Part B, such as flu, pneumonia, Hepatitis B (for at-risk individuals), and COVID-19, beneficiaries typically pay nothing. This 100% coverage applies when the healthcare provider accepts Medicare assignment, meaning they agree to Medicare’s approved payment amount.

For vaccines covered by Medicare Part D, as of January 1, 2023, a new prescription drug law ensures that most vaccines recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) are covered with no out-of-pocket costs. This means beneficiaries typically do not have deductibles, copayments, or coinsurance for these specific Part D-covered vaccines, including shingles and Tdap.

While many Part D vaccines are now cost-free, beneficiaries should verify coverage details with their specific Medicare Part D plan. Plan formularies can vary, so it is advisable to confirm how a particular vaccine is covered. Contacting the plan directly or discussing with the healthcare provider or pharmacy can help clarify any potential costs or network requirements before receiving a vaccination.