Does Medicare Cover Tetanus (TDAP) Shots?
This article was updated on: 09/12/2018
If your doctor has recommended that you receive a tetanus, diphtheria, and pertussis (TDAP) shot and you are a Medicare beneficiary, your vaccination may be covered if you are enrolled in a Medicare plan with prescription drug benefits.
The Part B program also covers vaccines that are necessary to treat an injury or illness. For instance, should a beneficiary need a tetanus vaccination related to an accidental puncture wound, it would be covered under Part B.
Why do I need a tetanus shot?
According to the Centers for Disease Control and Prevention, tetanus (also called “lock jaw”) is an infection that can be life threatening if left untreated. It is caused by a bacteria that thrives in dirt, soil, and feces, which can enter the skin through a cut or puncture wound in the skin. The infection can cause your muscles to painfully tighten, so that you have difficulty opening your mouth, swallowing, or even breathing.
Fortunately, a vaccination is available. The tetanus shot protects individuals from developing the tetanus infection if they are exposed to contaminated material. Infants and children receive the immunization as part of the DTap shot, which includes vaccinations against tetanus, diphtheria, and pertussis. Adults who were fully immunized with the TDAP vaccine as children should receive a tetanus booster shot every 10 years to maintain immunity; those who did not get the shot when they were younger may receive the TDAP shot as adults.
Your health-care provider may recommend a tetanus shot or TDAP vaccine if it has been 10 years since your last tetanus booster — or even earlier if you are at high risk for developing the infection, such as after an injury with a contaminated item.
Serious side effects from the tetanus shot are extremely rare, especially in adults. You may experience some redness or tenderness at the injection site. Contact your health-care provider immediately if you experience any of the following, as they may be signs of a severe allergic reaction:
- Hives or swelling of the face and throat
- Difficulty breathing
- Dizziness or weakness
- Rapid or irregular heartbeat
- Swelling, bleeding, or extreme pain in the arm where the injection was given
Medicare coverage of the tetanus shot
The TDAP vaccine, unlike the flu and pneumonia shots, are covered under Medicare prescription drug coverage, also known as Medicare Part D. If you are only enrolled in Original Medicare (Part A and Part B), you don’t get Part D coverage automatically. Instead, you can get coverage for your tetanus shot under Part D through a stand-alone Medicare Prescription Drug Plan.
Coverage for the TDAP shot is also available through a Medicare Advantage plan that includes prescription drug coverage. These plans must provide all the benefits available under Original Medicare, but in many cases, they include additional benefits not covered under Part A and Part B. Medicare Advantage plans often include benefits for routine vision or dental, hearing, and wellness programs, for example. They also often include prescription drug coverage, also known as Medicare Advantage Prescription Drug plans.
If you get your prescription drug benefits through a Medicare Advantage plan, you cannot enroll in stand-alone Medicare coverage for prescription drugs through a Medicare Prescription Drug Plan.
Medicare Part D generally covers all commercially available vaccines that are medically necessary to prevent illness. The vaccine must typically be prescribed and administered by a health-care provider who participates in Medicare, and your costs are usually lowest if the provider accepts Medicare assignment. There may be cost sharing (such as copayments or coinsurance) involved with Medicare coverage of the TDAP shot, which will vary by plan.
Depending on the type of Medicare plan you have, your plan may have additional rules about the doctors or providers you must use when getting the shot (for example, Medicare Advantage HMO plans may require that you get Medicare-covered services through in-network providers unless it’s an emergency). You should contact your Medicare plan for more information about the rules you need to follow to be covered for this vaccine.
Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans are both offered by Medicare-approved private insurance companies; each state may have different insurance companies authorized to provide prescription drug coverage. For this reason, plan benefits and costs (including premiums, copayments, and coinsurance) may vary from state to state.
Where can I get more information about Medicare coverage for the tetanus shot?
If you have questions about Medicare coverage for prescription drugs, including the TDAP vaccine, I am happy to assist you; click the “View profile” link to learn more about me. To schedule a phone call or request a personalized email, click one of the buttons below. Learn more about Medicare plan options available in your area by clicking the Compare Plans button.
For more information on the tetanus vaccine, see:
Centers for Disease Control and Prevention, “Tetanus: Make Sure Your Family is Protected,” last updated June 29, 2015.
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