Autumn is approaching and that means our immune system will be lower due to temperature drops, increased rain, and lack of vitamin D. This, in turn, increases our susceptibility to the most common seasonal fall illnesses. Medicare helps cover the cost of vaccines that assist in preventing illness. Now is a good time to start planning with your doctor which vaccines to include in your seasonal prevention plan.
Both Medicare Part B and Part D offer vaccinations. Part B provides outpatient medical coverage and Part D provides prescription drug coverage. Although Medicare drug plans provide most vaccine coverage, Part B covers vaccines as well, including certain vaccines related to a doctor’s treatment of an illness or injury. For example, Medicare Part B would likely cover a physician administered rabies shot if you are bitten by a dog.
Many of our yearly immunizations are covered under Part B, including:
- Seasonal flu shot
- Seasonal H1N2 (swine flu) vaccine
- Pneumococcal (pneumonia) vaccine
- Hepatitis B for intermediate or high-risk beneficiaries – if you do not meet the criteria, your Part D drug plan may provide coverage.
For vaccines that are not covered by Part B, Medicare Beneficiaries rely on the Part D coverage within their stand-alone or Medicare Advantage Plans.
This includes:
- Tetanus, diphtheria, and pertussis (Tdap) vaccine
- Herpes zoster (shingles) vaccine
- Measles, mumps, and rubella (MMR) vaccine
- Hepatitis A and hepatitis B vaccines for low-risk beneficiaries
- Certain self-administered insulin shots
As an important guide, the Centers for Disease Control and Prevention (CDC) makes age related vaccine recommendations. This includes:
- Influenza (flu) vaccine: 1 dose every year
- Tdap (tetanus, diphtheria, pertussis) booster: every 10 years or 1 initial dose if never received followed by boosters
- Zoster (shingles) vaccine: schedule based on recombinant or live
- Pneumococcal (pneumonia) vaccine: 1 dose at age 65
- Hepatitis A
- Hepatitis B
- Meningococcal (meningitis) A, C, W, Y
- Meningococcal (meningitis) B
- Haemophilus influenza type b (Hib)
- Varicella (chickenpox)
Although, copays vary across Medicare plans. You can refer to the formulary (drug list), to see if a shot is covered. Keep in mind, formularies do become outdated so your plan may cover a vaccine that is not listed. Pharmaceutical companies are currently developing vaccines for the 2019 novel coronavirus (SARS-CoV-2), in hopes of protecting against COVID-19. Once a vaccine becomes available, it will be covered by Medicare and by default, Medicare Advantage Plans since they must cover original medicare at a minimum.
Contact your Medicare agent to inquire about your senior healthcare coverage or if you have specific questions regarding your plan, the rules, administration, or payment of immunizations. Stay safe and be well.
About Dayna Schafer
Dayna is a licensed, professional Medicare advisor and broker, a member of the Rise Community. Her agency is located in Saint Petersburg, FL where she has helped hundreds of Medicare beneficiaries navigate the enrollment process by ‘Making it Make Sense’. Since 2002, Dayna has certified with triple the average amount of insurers in an effort to relentlessly seek out the right fit for her client’s healthcare needs.
