Does Medicare Cover All Adult Vaccines?
The medical community recommends specific vaccinations to reduce your risk of preventable diseases and severe illness. You may also need vaccinations required for employment, school and travel. In the United States, the Food and Drug Administration (FDA) is responsible for approval before a vaccine is available for public distribution.
The Centers for Disease Control and Prevention (CDC) assures the public that vaccination safety is a priority, reviewing safety information and monitoring adverse reactions. The Advisory Committee on Immunization Practices (ACIP) advises the CDC on who should get specific vaccines, when to administer them and what precautions are needed. The CDC uses ACIP recommendations to set standards of care across the U.S.
Original Medicare includes Part A, hospital insurance, and Part B, medical insurance. Part B preventive services include a limited range of shots, but Part D covers most recommended adult vaccines.
Medicare-covered vaccines under Part B
Your Part B benefits include flu, hepatitis B, pneumococcal and COVID-19 vaccines at no cost. There is no coinsurance, and the Part B deductible does not apply. Coverage for the hepatitis B vaccination is limited to people at medium-to-high risk. Talk to your doctor about the factors that may put you at risk.
If you get Part B through Original Medicare, use the provider search tool on the official Medicare website to identify Medicare-participating doctors and pharmacies. Medicare Advantage (MA) members should refer to the plan’s directory of network providers. To ensure you do not receive a bill, ask the practitioners administering your shots if they accept assignment from Medicare.
Medicare-covered vaccines under Part D
Your Medicare Prescription Drug Plan (PDP) or Medicare Advantage with prescription drug coverage(MA-PD) provides an approved drug list (formulary) for Part D-covered vaccines. The formulary lists recommended commercially available vaccines for illness or disease prevention not covered under Part B, such as shingles (ACIP-recommended Shingrix) and tetanus-diphtheria vaccines.
Each drug on the approved list is associated with a cost tier. The higher the tier, the higher your share of the drug cost. You may need to satisfy a deductible before a benefit payout. However, as of 2023, there is no longer a cost for Part D ACIP-recommended adult vaccines, consistent with zero cost-sharing for Part B-covered shots.
Your reason for getting the vaccine affects which part of Medicare covers the cost. For example, Part B covers tetanus shots when you get a puncture wound. You will need Part D coverage for non-injury-related tetanus shots you get to prevent illness.
Research and reporting
Visit the FDA and CDC websites to research the approval, availability, benefits and risks of specific vaccines. Inform your doctor if you experience a reaction to a vaccine. You can also report side effects by completing an online or downloadable form through the Vaccine Adverse Event Reporting System (VAERS), a program co-managed by the CDC and FDA.