Medicare covers some vaccines and immunizations. The way Medicare covers them depends on which vaccine you need.
Your Medicare health coverage (Part B) will cover vaccines to prevent:
- Influenza (the flu);
- Currently, the seasonal flu shot includes both a seasonal flu shot and an H1N1 (swine flu) vaccination.
- Pneumonia; and
- Hepatitis B (if you are at medium to high risk).
Part B will cover other immunizations only if you have been exposed to a dangerous virus or disease. For example, if you step on a rusty nail, Medicare will cover a tetanus shot; if you are bitten by a dog, Medicare will cover your rabies shots.
Note: If you are in Original Medicare, there has been no coinsurance or deductible for the Hepatitis B vaccine if you see providers who accept assignment. The pneumonia and flu vaccines are still covered with no copay or deductible if you see providers who accept assignment. Doctors and other health care providers who accept assignment cannot charge you more than the Medicare approved amount. Medicare Advantage (MA) plans will cover all preventive services the same as Original Medicare. MA out-of-pocket costs for vaccines and immunizations will vary depending on the type of shot. Your costs will also vary depending on if you have an in-network or out-of-network doctor administer the injection.
All vaccines other than those for the flu, pneumonia or hepatitis B are covered under Medicare Part D. If you have a Medicare prescription drug plan (Part D), you can get coverage for any commercially available vaccine that is not covered by Part B. All Part D plans must include all commercially available vaccines on their formularies, including the vaccine for shingles (herpes zoster). Your Part D plan will pay for the vaccination itself and for your doctor or other health care provider to give you the shot (administration). Before you get a vaccination, you should check coverage rules with your Part D plan and see where you should get your shot so that it will be covered for you at the lowest cost.