Does Medicare Cover a Measles Vaccine? 

Measles is a contagious but preventable infection caused by a virus. Although no antiviral treatment is available, measles is preventable due to the MMR vaccine, which stands for measles, mumps and rubella. The MMR vaccines available in the U.S. are M-M-R II and PRIORIX. Healthcare providers can give children an MMRV vaccine, which includes protection against varicella (chickenpox).

The Centers for Disease Control and Prevention (CDC) recommends the MMR vaccine begin for children at 12 months. If you were born before 1957, most likely you were infected with measles as a child and developed immunity. Standard use of the vaccine began in the 1960s. People without immunity who get exposed to an infected individual should get the MMR vaccine within 72 hours to prevent measles or at least reduce its severity. 

Medicare vaccine coverage

Medicare Parts B and D cover medically necessary vaccines approved by the U.S. Food and Drug Administration (FDA). Part B covers seasonal flu, hepatitis B, pneumococcal and COVID-19 vaccines. These shots are preventive services, available at no cost when administered by a Medicare-participating healthcare provider. The hepatitis B shots are for beneficiaries with, at minimum, medium-level risk factors for the hepatitis B virus infection.

Generally, all other recommended vaccines commercially available for illness prevention are covered under your Medicare-approved prescription drug plan (Part D). Adult immunizations include shingles, tetanus, diphtheria and pertussis. Look for MMR vaccines in your Part D formulary, the plan’s approved list of drugs.  

Cost of Part D vaccines

When you review your formulary, search for M-M-R II and PRIORIX in the tier designated for preferred brand drugs. Part D vaccine costs depend on several variables: your drug category (generic, brand or specialty), drug benefit phase (deductible, initial, coverage gap, or catastrophic), plan’s cost-sharing requirements, and use of the plan’s network and preferred pharmacies.

If you have difficulty paying drug costs, you can apply to the Extra Help program, which helps beneficiaries with limited financial resources. You automatically qualify for the Extra Help program if you receive Supplemental Security Income (SSI), Medicaid for Part B premiums or full Medicaid coverage.

Medicaid vaccination coverage

Some Medicare beneficiaries have Medicaid coverage as well. Medicaid is a program that provides specific populations access to healthcare coverage. Eligible groups include low-income families, pregnant women, children and SSI recipients. States can add other groups, and Medicaid reports that most states have expanded coverage to individual adults with incomes below specific thresholds.

Effective October 1, 2023, when the Advisory Committee on Immunization Practices (ACIP) recommends an FDA-approved adult vaccine, Medicaid and Children’s Health Insurance Program (CHIP) must cover the vaccine at no cost to the beneficiary. This statutory amendment applies to full Medicaid and CHIP beneficiaries aged 19 and older. 

More information

Visit the CDC and World Health Organization websites for comprehensive information about measles, mumps and rubella, and the vaccine to prevent these diseases.

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