Vaccines Covered By Medicare Part B
Medicare Part B covers three important vaccines as part of its preventive care benefits.
Covered vaccines include the following:
- Flu vaccine: Annual vaccine given in one shot before or during flu season, usually November through April
- Pneumonia vaccine: One-time vaccine given in two shots at least one year apart
- Hepatitis B vaccine: One-time vaccine given in two to four shots over one to six months for people who are medium to high risk, including people with diabetes
Part B also covers vaccines you may need if youre exposed to a harmful virus or bacteria by accident. You might need a tetanus shot, for example, if you step on a rusty nail. Or you may need rabies shots if youre bitten by a stray dog.
Find Out How Medicare Pays For Flu Shots
Medicare is defined in 4 parts: A, B, C and D. The combinations of Medicare Parts A and B is known as the . Medicare Part C is known as Medicare Advantage. Whether youre enrolled in the Original Medicare program or a Medicare Advantage plan, know that your flu shot is covered by Medicare.* The information below provides details about how Medicare covers the flu vaccine depending on the type of Medicare program youre enrolled in.
*The cost of the shot may be affected if the provider is out of your network.
Enrolled in an Original Medicare plan? Discover how your flu shot is covered.
Original Medicare is commonly known as traditional Medicare and is made up of 2 parts: Medicare Part A and Medicare Part B . This program is offered by the federal government and provides members with a flu shot without a deductible or copay. The flu vaccine must be given by a physician, pharmacist or healthcare provider who accepts Medicare. This means the healthcare provider has agreed to provide this service and accept payment from the Medicare program/plan at a set rate. It is best to call ahead to find out if Medicare pays for flu shots at your pharmacy.
Got a Medicare Advantage plan? Find out how your flu shot is covered.
Vaccines Covered By Medicare Part D
Medicare Part D covers all commercially available vaccines needed to prevent illness. You can get Part D coverage through a stand-alone Medicare prescription drug plan or a Medicare Advantage plan that includes drug coverage.
Vaccines covered by Part D include the following:
- Shingles vaccine: One-time vaccine given in two shots over two to six months
- Tdap vaccine : One shot if youve never been vaccinated, and a booster every ten years
- Other vaccines covered: Vaccines that are “reasonable and necessary” to prevent illness and are not covered by Part B
Part D may also cover vaccines you may need if you are traveling internationally. Talk with your doctor about your travel plans and ask what vaccines are recommended.
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Go Through A State Pharmaceutical Assistance Program
Medicare Part D plans have a yearly deductible. After you reach your Medicare Part D plans deductible, you will still be required to pay a copayment or coinsurance for your shingles vaccine. However, if you go through a State Pharmaceutical Assistance Program , you may be able to get help with these costs.
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Medicare Part B Covers Preventive Services Including Flu Shots
Medicare Part B is your medical insurance. It covers preventive services, like the flu shot. Medicare pays for one shot per season but may cover a second if its medically necessary. Medicare coverage includes flu shots that are approved by the U.S. Food and Drug Administration for people over the age of 65. Covered flu shots include Fluad and Fluzone High-Dose, according to the CDC.
Dr. Ganguli recommends the high-dose flu vaccination for anyone older than 65.
There are other types of influenza vaccines approved for adults, however, not specifically for people over the age of 65. These can be given to people over 65 years of age if the high-dose flu vaccine is unavailable or not preferred for any reason. These include:
- Quadrivalent cell-based influenza shot including Flucelvax Quadrivalent
- Recombinant quadrivalent influenza shot including Flublok Quadrivalent
Medicare does not cover nasal spray flu vaccines, as the FDA has not approved them for this age group.
Medicare Part B also covers COVID-19 vaccines, a seasonal H1N1 swine flu vaccine, a pneumococcal vaccine, and hepatitis B shots for individuals considered high-risk.
Part B also includes certain shots if theyre related to treatment for illness or injury. For example, if your doctor treats an injury with a tetanus shot.
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Costs Of Flu Shots Under Medicare
If youre enrolled in Medicare, you can receive one free flu shot each flu season at no cost to you.
Medicare Part B covers the vaccination, and all deductibles and copayments are waived.
If youre enrolled in a Medicare Advantage plan, the shot is still free, but you may need to have it administered by a doctor or pharmacy inside your plans provider network.
Will Medicare Pay For My Flu Shot
En español | Yes. Medicare Part B, which covers doctor and outpatient services, pays for one flu shot each flu season, which starts in the fall and continues through winter and early spring.
Considering flu shots as free preventive services, Part B covers the immunization without any deductibles or copayments as long as you use a provider or pharmacy that accepts Medicare assignment. This means that either of them has agreed to accept the Medicare-approved payment as full reimbursement for the shot.
If you have coverage through a private Medicare Advantage plan, rather than original Medicare, that plan also must pay for one flu shot per season without any deductibles or copayments. Medicare Advantage may require you to use an in-network provider or pharmacy.
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Are Flu Shots Free For Seniors
Without insurance, flu shots are typically not free for seniors. If you dont have Medicare or some other form of insurance and are planning to pay out-of-pocket, then your annual flu shot can cost you as much as $50 or more.
Medicare covers the entire cost of a flu shot, so shots are free if you have insurance.
If you dont have insurance, there may be cheap options available near you. Check to see if there are any local resources, like health clinics or local pharmacies, that may be offering free or low-cost flu shots.
Influenza Vaccinations Administered In Pharmacies And Physician Medical Offices Adults United States
Back to Main Page | Doses Distributed | Child Coverage | Pregnant Persons Coverage | Adult Coverage | Medicare Beneficiaries Coverage | Adult Pharmacy and Medical Office Vaccinations
- CDC is exploring use of data obtained from IQVIA§ as a source of information on vaccinations administered in retail pharmacies and physician medical offices. merchandise, food stores, and independent pharmacies) and physician medical offices. Evaluations of these data are underway.
- These projected pharmacy estimates include flu vaccinations that were billed for or paid by cash. Medical office projected estimates are claims-based only.
- Vaccinations administered in other settings such as workplaces and community settings are not included in these data.
- Figure 6. Weekly Cumulative Estimated Number of Influenza Vaccinations Administered in Pharmacies and Physician Medical Offices by Flu Season*, Adults 18 years and older, United States, Data Source: IQVIA Pharmacy and Physician Medical Office Claims. Data are current through November 26, 2022.
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What Are The Complications Of Shingles
The most common and lasting complication of shingles is nerve pain, whats called postherpetic neuralgia , which can last for months or even years, long after the rash has cleared up. According to the CDC, between 10% and 18% of people whove had shingles will develop PHN.
PHN is a stabbing or throbbing pain or weakness where the shingles rash had been. The risk increases with age and the pain lasts longer and is more severe than in younger people.8
In rare cases, shingles can develop into pneumonia, hearing problems, blindness and brain inflammation.9 Only 1% to 4% of people with shingles are hospitalized for complications, though these are typically older adults and people whose immune systems are weak or suppressed, and fewer than 100 people die from shingles each year.10
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Does Medicare Advantage Cover The Shingles Vaccine
Medicare Advantage plans are private health insurance plans that are approved by Medicare. Medicare Advantage plans must cover the same services as Medicare Part A and Part B, but they can also offer additional benefits. Some Medicare Advantage plans may cover the shingles shot, but it is not required. It is important to talk to your insurance broker or insurer to find out whether your Medicare Advantage plan will cover the vaccine.
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Are Flu Shots Free If You Are On Medicare
You wont have to pay for your flu shot with Medicare as long as you get it from your doctor or another qualified healthcare provider. Original Medicare coverage includes flu shots from any provider that accepts Medicare. Those with Medicare Advantage coverage may need to get their flu shot from an in-network provider.
How Does Medicare Cover The Shingles Vaccine
Original Medicare, Part A and Part B, does not cover the shingles vaccination but Medicare Part D does. To get this covered, you must enroll in either a stand-alone Medicare prescription drug plan or a Medicare Advantage plan that includes prescription drug coverage . You may have a copayment for the shingles vaccine.
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Do Medicare Advantage Plans Cover Flu Shots
Medicare Advantage plans cover flu shots since they must, at minimum, cover everything under Original Medicare.
Just like with Original Medicare, you will pay nothing for this and will be covered for a flu shot each flu season.
The one difference is that Medicare Advantage plans typically require you to receive care within a plan network. So, you may have to get your flu shot from a doctor or facility that is included in your plan instead of getting the shot from any doctor who accepts Medicare.
This also may affect whether you can get the flu shot at your local pharmacy if it is outside your network. If you have Medicare Advantage and youre not sure where you can get a flu shot, you can check with your plan provider.
Who Should Not Get The Shingles Vaccine
The vaccine may not be appropriate for people who have a weakened immune system due to certain conditions. These people include those with an organ transplant and those who are undergoing chemotherapy to treat cancer.
Doctors also recommend that people with an allergy to any component of the vaccine the shingles vaccination.
Anyone with severe allergies must tell a doctor about them when discussing their shingles risk. People who are pregnant or breastfeeding or currently have shingles symptoms should not get the shot.
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Medicare Part A Covers Hospital Staysflu Shot Not Included
Medicare Part A covers:
- Home health care
It does not cover the flu shot.
Medicare Part A is free to eligible people aged 65 or older. Generally, if you or your spouse paid Medicare taxes for at least 10 years, this portion of Medicare is free. You can sign up for this starting three months before your 65th birthday. If you have been receiving social security benefits before your 65th birthday, you are automatically enrolled in Part A. Otherwise, you need to sign up for it either online or at a social security office.
Where To Get A Flu Vaccine
Getting a flu vaccine is easy, and it is the first and most important step you can take in protecting yourself and your loved ones from flu. There are a number of places where you can get flu vaccine, including your local health department, vaccination clinics, doctors’ offices, retail pharmacies, and some schools and workplaces.
Contact your doctor or Local Health Department to ask about flu vaccine availability, or for a list of flu vaccination clinics near you, please visit the Vaccine Finder.
Most flu vaccine is free or low cost with insurance however, if you are uninsured or underinsured there are options available.
The Michigan VFC Program provides vaccines at no cost to children less than 19 years of age and are either Medicaid-eligible, uninsured, underinsured, or American Indian/Alaska Native. Ask your healthcare provider if they are a VFC provider or contact your Local Health Department.
The Michigan AVP Program provides vaccine at no cost to adults 19 years and older seen at participating providers such as Local Health Departments, Federally Qualified Health Centers, Tribal Health Centers, Migrant Health Centers, and more!
If you are a health care professional looking for flu vaccine, please visit the National Influenza Vaccine Summit webpage. Other resources include:
If you are a VFC provider looking for VFC flu vaccine, please contact your Local Health Department.
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How Much You Might Still Have To Pay
According to Consumer Reports, the shingles vaccine costs around $217 at full price, but the average cost for people with Medicare Part D is $50 for each shot. Some plans have a higher copay, while some plans charge less or even $0.
Before you go to the pharmacy to get vaccinated, call them to find out the current price of the vaccine, and call your insurer to confirm that they will cover it. To get the lowest copay, make sure the pharmacy is in your insurers network.
You can also ask your doctor about getting vaccinated at the doctors office, but make sure to ask them how much they charge for the vaccination and if they can bill your insurer.
Some doctors may charge more for the vaccine than your insurer will cover, and some may expect you to pay out of pocket and be reimbursed later. If your doctor cant bill your insurer, then ask them to write you a prescription for an in-network pharmacy instead.
What Do I Need To Know About Flu Shots
Who is this for?
Blue Cross Blue Shield of Michigan and Blue Care Network members under age 65. If you’re a Medicare member, please visit our Medicare flu and pneumonia shots page to learn more.
There’s never been a more important time to get your flu shot. You can learn about it here. You might also want to know the symptoms of the flu versus COVID-19.
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Does Medicare Cover The Shingles Vaccine In 2022
En español | No and yes. Medicares Part A and Part B dont cover shingles vaccinations, even though the Centers for Disease Control and Prevention recommends that everyone age 50 and older get the vaccine. Medicare Part B covers some other vaccines as free preventive care, such as the flu and pneumonia vaccines.
With that said, Medicare Part D covers the shingles vaccine, as do private Medicare Advantage plans that include drug coverage. These plans must cover all commercially available vaccines needed to prevent illness, except for those that Part B covers.
In the United States, about 1 in every 3 people are at risk for shingles or herpes zoster, the same virus strain that causes chicken pox. If youve had chicken pox, the virus stays dormant in your system and may reappear as shingles later in life, which is why the vaccine is recommended.
How Long Does The Flu Shot Last
Once you get that flu shot, it’ll last you about six months, said Vanessa Raabe, MD, pediatric infectious disease specialist at NYU Langone Healthwhich means the flu shot you got last year most definitely won’t give you any protection for this year’s flu season. Plus, the CDC says that the flu vaccine changes from year to year as scientists try to predict which strains of the virus will be dominant. So last year’s shot wouldn’t protect you as well as this year’s anyway.
While you can technically still get the flu shot well into flu season , it’s still wise to get it ASAPespecially when, for most people, it takes less than a minute of your time, and can be totally free. That’s right, with most health insurance, a flu vaccine costs exactly zero bucks.
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Importance Of Flu Shots For Seniors
Eating well, staying active and working with your doctor to control any medical problems you might have will help you enjoy a healthy life well into your older years. Still, aging takes a toll on your immune system, making it less capable of fighting infections like the flu. As you get older, you’re more likely to catch the flu. You’re also more likely to develop serious problems, like pneumonia, if you come down with the flu. Americans age 65 and older are more likely than any other age group to be hospitalized for the flu, and approximately 9 out of 10 flu deaths in the U.S. occur in this age group, according to the Centers for Disease Control and Prevention .
Local Health Departments Community Centers Or Religious Sites
Many county health departments offer free flu shots during flu seasonwith or without insurance. Contact your county’s health department to see if you can benefit from this service. Even if you don’t have health insurance , you may be able to get the jab without cost through local churches and synagogues, free clinics, and community centers.
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