Which Vaccines Are Covered By Medicare?

Vaccines are an all-important first line of defense against a wide range of infectious diseases. They are crucial to public health because of their ability to prevent individuals from contracting and spreading diseases within their communities. 

Coronavirus vaccines, for instance, have now been administered to over 270 million Americans, or more than 81% of the U.S. population. U.S. citizens who are eligible for Medicare are also guaranteed several other vaccines. 

Recipients should understand their vaccine coverage under each type of Medicare and how beneficiaries can get access to these vaccines. 

Vaccines covered by Medicare Part B

1. Influenza (Flu) Vaccines: Medicare Part B covers the seasonal flu vaccine, which is updated annually to target the most prevalent strains of the flu virus. This is one of the simplest and most effective ways Medicare beneficiaries can protect themselves from a virus that poses particularly serious risks for adults 65 and older — and it won't cost you a cent from a participating provider.

2. Pneumococcal Vaccines: Medicare Part B covers two types of pneumococcal vaccines – the pneumococcal polysaccharide vaccine (PPSV23) and the pneumococcal conjugate vaccine (PCV13). These vaccines help protect against infections caused by pneumococcal bacteria, which can cause pneumonia, meningitis, and other severe illnesses — conditions that can be life-threatening in older adults and those with compromised immune systems.

3. Hepatitis B Vaccines: Medicare Part B covers hepatitis B vaccines for individuals at high or intermediate risk for the disease, including those with chronic liver disease, healthcare workers, and individuals with certain medical conditions. If you fall into a risk category, this coverage is available to you at no cost from a Medicare-participating provider.

Vaccines covered by Medicare Part D

Medicare Part D, which provides prescription drug coverage, may cover certain vaccines that are not covered under Part B. The specific vaccines covered under Part D can vary depending on the insurance plan you choose, as Part D plans are offered by private insurance companies. Some commonly covered vaccines under Medicare Part D include:

Shingles Vaccine: Medicare Part D typically covers the shingles vaccine, which helps prevent herpes zoster (shingles) in older adults. There are several shingles vaccines available, including Zostavax and Shingrix. Shingles is both painful and potentially serious — and with the Shingrix vaccine showing over 90% effectiveness at preventing it, this is one coverage benefit worth actively using.

Tdap Vaccine: Medicare Part D may cover the Tdap vaccine, which protects against tetanus, diphtheria, and pertussis (whooping cough). Adults need a Tdap booster every ten years, and for older adults who may be around infants or immunocompromised individuals, staying current matters greatly.

Vaccines that are “Reasonable and Necessary”: Medicare Part D may also cover other vaccines that Centers for Medicare & Medicaid Services (CMS) deems “reasonable and necessary.” These may include vaccines for conditions such as pneumonia, meningitis, or other diseases — so it's always worth checking with your Part D plan about any vaccine your doctor recommends.

Vaccines not covered by Medicare

While Medicare provides coverage for a wide range of vaccines, it doesn't cover certain vaccines. These include:

Travel Vaccines: Vaccines required for travel purposes, such as yellow fever or typhoid vaccines, are generally not covered by Medicare. Because they are not considered medically necessary for the treatment or prevention of conditions in the ordinary course of Medicare-covered care, beneficiaries planning international travel will typically need to pay out of pocket or seek coverage through other means — such as travel insurance or a local travel health clinic.

Non-Medicare Preventive Vaccines: Vaccines that are recommended for preventive purposes but not specifically included in Medicare's coverage guidelines may not be covered. If your doctor recommends a vaccine that falls into this category, it's worth checking with both your Medicare plan and any supplemental coverage you carry before assuming you'll owe the full cost.

Eligibility Criteria for Coverage

Multiple factors determine eligibility for vaccine coverage under Medicare. They include:

Age requirements

Medicare generally covers vaccines for individuals who are eligible for Medicare benefits. This typically includes individuals who are 65 years of age or older. However, individuals under 65 may also be eligible for Medicare coverage if they have disabilities or are suffering from end-stage renal disease (ESRD). If you're not yet 65 but are enrolled in Medicare through one of these qualifying conditions, your vaccine coverage rights are the same as those of any other Medicare beneficiary.

Health conditions that warrant vaccine coverage

There are a few specific health conditions that may warrant vaccine coverage under Medicare. Individuals with chronic medical conditions or weakened immune systems who are more susceptible to vaccine-preventable diseases may qualify for coverage. 

The specific conditions considered here include chronic lung disease, heart disease, diabetes, and other conditions that increase the risk of complications from vaccine-preventable diseases. If you live with one of these conditions, it's worth having a direct conversation with your doctor about which vaccines are appropriate — and making sure your Medicare coverage is being fully utilized.

Enrollment

To receive vaccine coverage under Medicare, you must be enrolled in the appropriate Medicare program. Original Medicare (Part A and Part B) covers some vaccines, while other vaccines may be covered under Medicare Part D, which provides prescription drug coverage. If you don't have Part D coverage, you may have a gap in vaccine coverage that's worth addressing during the next Annual Election Period. 

Remember, coverage for vaccines may vary depending on the specific Medicare plan you have, as individual plans have different coverage requirements and limitations. When in doubt, call your plan before getting vaccinated — a quick phone call can prevent a surprising bill. 

Accessing vaccines under Medicare Coverage

You can gain access to the vaccines covered under your Medicare plan through multiple channels. They include: 

Vaccination at a doctor’s office

One option is to receive your vaccination at a doctor's office. You can schedule an appointment with your primary care physician or any healthcare provider who is eligible to administer vaccines. The doctor's office will bill Medicare directly for the cost of the vaccine and its administration — meaning you typically walk out without owing anything for covered vaccines.

Vaccination at a pharmacy

Medicare beneficiaries also have the option to receive vaccinations at participating pharmacies. Many approved pharmacies such as CVS, Walgreens, and Rite Aid offer vaccination services. You can simply visit a participating pharmacy and request the vaccine. The pharmacy will administer the vaccine and bill Medicare directly — making this a convenient, no-appointment option that's accessible for most beneficiaries.

Vaccination at a clinic

Another option is to receive the vaccine at a clinic. Community health clinics, public health departments, and other healthcare facilities may offer vaccination services. These clinics often provide vaccines at a reduced cost or on a sliding fee scale based on income. You can inquire about vaccine availability and schedule an appointment at the clinic of your choice.

Costs of vaccines under Medicare

The costs of vaccines under Medicare can vary depending on the specific vaccine, the type of Medicare coverage you have, and where you receive the vaccination. Here are some key points to consider:

Medicare Part B Coverage

Vaccines for influenza (flu), pneumococcal diseases, and hepatitis B are some of those covered under Medicare Part B. The plan covers 100% of the cost when administered by a healthcare provider who accepts Medicare assignment. This means you should not have any out-of-pocket costs for these vaccines as long as they are deemed medically necessary — no deductible, no coinsurance, no cost.

Medicare Part D Coverage

Some vaccines may be covered under Medicare Part D, which provides prescription drug coverage through private insurance plans. The specific vaccines covered under Part D can vary depending on the insurance plan you choose. 

Make sure to review your Part D plan's formulary or contact your insurance provider to understand which vaccines are covered and whether they involve any associated costs, such as copayments or deductibles. Thanks to provisions in recent legislation, many Part D vaccines that were previously subject to cost-sharing are now available at no cost to beneficiaries.

Pharmacy and provider Costs

While Medicare covers the cost of the vaccine itself, there may be additional costs related to administration fees or services. If you receive the vaccine at a doctor's office or clinic, Medicare should cover the administration fees. 

If you choose to get vaccinated at a pharmacy, however, there may be a nominal fee for administering the vaccine. These costs can vary depending on the pharmacy and the specific vaccine — so it's a good idea to confirm the pharmacy's billing process with your Medicare plan before your appointment.

Out-of-pocket costs and deductibles

Make sure to find out if any deductibles or out-of-pocket costs are associated with your Medicare vaccine coverage. For instance, if you have a deductible for Medicare Part B, you may need to meet that deductible before Medicare covers the cost of vaccines. 

There may also be copayments or coinsurance for vaccines if you have a Medicare Advantage or a Medicare Part D plan. Each plan handles cost-sharing differently, which is why reviewing your plan's specific vaccine benefits each year during the Annual Election Period is such a valuable habit.

FAQs About Medicare vaccine coverage 

Is the COVID vaccine covered by Medicare?

Yes, Medicare provides coverage for the COVID-19 vaccine. Both the vaccine itself and its administration are covered under Medicare Part B. Medicare beneficiaries are eligible to receive the COVID-19 vaccine at no cost. This coverage applies to all COVID-19 vaccines that have received emergency use authorization from the US Food and Drug Administration (FDA) or have been approved by it — making this one of the most accessible and cost-free preventive benefits available through Medicare.

Does Medicare cover travel vaccines?

Generally, Medicare does not cover vaccines required for travel abroad, such as yellow fever or typhoid vaccines. That's because they are not considered “reasonable and necessary” for Medicare coverage. If you require travel vaccines, you may need to explore other options, such as private insurance plans, travel clinics, or paying out-of-pocket for the vaccines. Planning ahead — and factoring vaccination costs into your travel budget — is the prudent approach.

What should I do if I have questions about Medicare coverage for vaccines?

If you have questions about Medicare coverage for vaccines or need more information, there are a few steps you can take:

Contact Medicare: You can contact Medicare directly by calling 1-800-MEDICARE (1-800-633-4227) or visiting the official Medicare website at medicare.gov. They can provide general information and answer specific questions related to your coverage.

Reach out to Your Medicare Insurance Provider: If you have a Medicare Advantage plan or a Medicare Part D plan, you can contact your insurance provider directly for information about vaccine coverage, costs, and any associated requirements. Your insurer's member services team can tell you precisely which vaccines are covered, what your cost-sharing obligation is, and where you can get vaccinated within your plan's network.