What Vaccines are Covered under Medicare Part D?
This article was updated on: 09/01/2017
While no one enjoys getting shots, staying up to date on your vaccines could have important health benefits; they could help you avoid disease, hospitalization, and even death. According to U.S. Department of Health & Human Services, a vaccine is a product that produces immunity from disease. They could be administered by needle injections, by mouth, or by aerosol (spray).
People aged 60 and older may be especially vulnerable to certain diseases that could be prevented by vaccines. According to the Centers for Disease Control and Prevention (CDC), about 500,000 Americans age 60 and older get shingles (caused by the varicella zoster virus) every year. Fortunately, there is a vaccine which may protect against shingles. The CDC also reports that about 60% of seasonal flu-related hospitalizations are in people age 65 and older. These hospitalizations might be avoided with the flu vaccine that protects against the influenza virus.
According to the U.S. Department of Health & Human services, the following vaccines may be recommended for older adults: influenza (flu), shingles, diphtheria, tetanus, pertussis, and pneumococcal disease (pneumonia). (This list of vaccines may not be right for you. Ask your doctor what he/she recommends for you.) Medicare Part B or Part D generally cover many preventative vaccines. See below what Medicare vaccine coverage you may get for each of these shots:
According to the Centers for Disease Control and Prevention (CDC), influenza (flu) is a contagious respiratory illness. Symptoms might include fever, body aches, cough, runny nose, and fatigue. Flu complications in adults age 65 or older could result in hospitalization or death. Flu shots are generally covered by Medicare Part B. Usually one shot is covered per flu season and you pay nothing for the flu shot if the doctor or health-care provider accepts Medicare assignment.
Shingles (herpes zoster)
Shingles is a painful rash that typically develops on one side of the face or body, according to the CDC. Shingles is caused by the same virus that causes the chickenpox: the varicella zoster virus. Very rarely, shingles can lead to pneumonia, hearing problems, blindness, brain inflammation or death, according to the CDC. The shingles shot isn’t covered by Medicare Part A or Part B, but is generally covered by Medicare Prescription Drug Plans (Part D). Medicare Part D plans generally cover all commercially-available vaccines. You will have to contact your plan for specific information about coverage of a particular vaccine.
Diphtheria and Tetanus (Tdap)
Diphtheria is a bacterial infection that can cause weakness, sore throat, fever, and swollen glands in the neck, according to the Centers for Disease Control and Prevention. It may also cause damage to the heart, kidneys, and nerves. Tetanus is also a bacterial infection that can cause lockjaw, muscle spasms, seizures, changes in blood pressure and a fast heart rate. Breathing difficulty caused by tetanus can lead to death, according to the CDC. The Tdap vaccine helps prevent diphtheria and tetanus, according to the CDC. Generally Medicare Prescription Drug Plans (Part D) cover all commercially-available shots needed to prevent illness, such as the Tdap. Contact your plan for more information about Medicare Part D vaccine coverage.
Pertussis (whooping cough)
According to the CDC, pertussis (whooping cough) can cause violent and rapid coughing until you are forced to inhale with a loud “whooping” sound. This coughing can cause vomiting and exhaustion. Like diphtheria and tetanus, whooping cough is caused by bacteria and may be prevented by the getting same Tdap vaccine described above. Generally Tdap is covered by a Medicare Prescription Drug Plan. In fact, all commercially-needed shots needed to prevent illness are generally covered by Medicare Prescription Drug Plans. A plan may even cover a vaccine not stated in its formulary.
Pneumonia (pneumococcal) vaccines
Medicare Part B usually covers the pneumococcal vaccines to prevent pneumonia. Doctors might give you two different shots, taken a year apart. You generally pay nothing for the pneumococcal shots if your doctor or other health-care provider accepts Medicare assignment
How to get Part D coverage
You can get Medicare Part D coverage either through a stand-alone Part D Medicare Prescription Drug Plan or through a Medicare Advantage plan that includes prescription drug coverage. Both stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage plans are available from private, Medicare-approved insurance companies. With a stand-alone Medicare Part D Prescription Drug Plan, you will keep your Original Medicare (Part A and/or Part B) coverage. A Medicare Advantage plan is another way to get you Part A and Part B benefits although you must continue to pay your Part B premium as well as any premium the plan may charge. Hospice benefits are still covered directly under Medicare Part A.
Would you like to know more about Medicare coverage of vaccines? I’d be happy to help you. I can walk you through your options or email you information; you can request that using the links below. Or take a look at plans by clicking the Compare Plans buttons on this page. Feel free to call Medicare.com’s licensed insurance agents at 1-844-847-2660, TTY users 711; Monday through Friday, 8AM to 8PM ET.