VACCINES FOR SENIORS

Michael T. Braden January 13, 2025 Medicare Part D

VACCINES FOR SENIORS

HOW MEDICARE COVERS VACCINES IN 2025

Vaccines play a crucial role in preventing several serious infectious diseases.

Luckily, Medicare covers the cost of most vaccines. However, Medicare itself is comprised of four different parts, so it’s helpful to know which parts cover which vaccines.

 

 

 

QUICK MEDICARE OVERVIEW

Part A – Covers hospital stays.

Part B – Covers doctor visits and preventive services.

Part C – Medicare Advantage plans include Parts A and B, often bundled with additional benefits such as dental, vision, and hearing coverage.

Part D – Covers prescription drugs.

Vaccines fall under both Medicare Part B and Medicare Part D.

WHICH VACCINES FALL UNDER MEDICARE PART B

Medicare Part B is the medical insurance portion of Medicare. It helps cover the costs of doctor visits, outpatient care, and some preventive services, including certain vaccines. Medicare Part A (hospital insurance) and Part B together make up what’s called Original Medicare. The federal government provides Original Medicare.

 MEDICARE PART B COVERS THE VACCINES FOR THESE CONDITIONS:

• Flu
• Pneumonia
• Hepatitis B (for people at medium or high risk for Hepatitis B)
• COVID-19

You won’t pay anything for these vaccines as long as your provider accepts Medicare. If you have Original Medicare, please bring your red, white, and blue Medicare card to your appointment.

WHICH VACCINES FALL UNDER MEDICARE PART  

Medicare Part D is the prescription drug portion of Medicare. You can get Medicare Part D through a standalone prescription drug plan or through a bundled Medicare Advantage (Part C) plan. Private insurance companies provide Part C and Part D plans.

Part D plans cover all the vaccines that the Advisory Committee on Immunization Practices (ACIP) recommends, unless they are covered by Part B.

MEDICARE PART D COVERS THE VACCINES FOR THESE CONDITIONS:

• Shingles
• RSV (Respiratory Syncytial Virus)
• Tetanus
• Whooping cough
• Diphtheria
• Hepatitis A
• Hepatitis B (if not covered under Part B

Your Part D plan formulary will list all the vaccines that are covered by the plan. Be sure to discuss your vaccination needs with your healthcare provider. Their recommendations can vary depending on your health status and medical conditions. As healthcare research continues, new vaccines may be developed. These advancements could affect Medicare’s coverage in the future.

Keeping up with these changes ensures you can make the best health choices. Understanding your Medicare coverage is essential to maintaining your health—and to protecting the health of your loved ones and friends.

FREQUENTLY ASKED QUESTIONS ABOUT VACCINE

DOES MEDICARE COVER THE RSV VACCINE?

RSV is a respiratory illness. Medicare Part D will cover the cost of the RSV vaccine. If you only have Original Medicare (Parts A and B), it won’t be covered. The CDC recommends the RSV vaccine for everyone over 75, and some adults ages 60-74. Medicare Part D will cover the cost of the RSV vaccine

IS THE SHINGLES VACCINE COVERED BY MEDICARE?

Medicare Part D will cover the cost of the shingles vaccine. For more information, speak with your healthcare provider and explore the CDC recommendations on the Shingles vaccine.