Medicare Part D Covers Flu Medications And Other Vaccines You May Need
Medicare Part D is an optional prescription drug plan. Plans vary in copayments, coinsurance, deductibles, and drug coverage. These plans cover other vaccines when they are reasonable and medically necessary. Common vaccines covered under Part D include:
- All Part D plans must cover the shingles vaccine, Shingrix
- Tdap vaccine for tetanus, diphtheria, and pertussis
- MMR vaccine
- BCG vaccine for tuberculosis
- Meningococcal vaccines
- Hepatitis A and hepatitis B vaccines for individuals considered high-risk
The amount you pay for your vaccine may vary depending on where you get vaccinated, says Gail Trauco, RN, BSN-OCN, a patient advocate and founder of Medical Bill 911. Be sure to check your plans coverage rules and see where you can get your vaccine at the lowest cost. Typically, you will pay the least for your vaccinations at in-network pharmacies or at a doctors office that coordinates with a pharmacy to bill your Part D plan for the drug and the injection.
Although the flu shot is not covered by Medicare Part D, antiviral medications used to treat the flu are covered. These include generic Tamiflu, Relenza, and Xofluza.
Where To Get Vaccinated
You have a choice on where to get vaccinated.
In your doctors office: You can get vaccinated in your doctors office. If the office is set up to bill Part D directly for your vaccination, you may only have to pay a copay at the time of your shingles shot. If not, you may have to pay all costs upfront and submit a claim to your Part D plan for reimbursement.
At your local pharmacy: You can go to your local pharmacy to get your shingles shot as long as they offer the vaccine and appropriately trained staff members administer it. The rules for pharmacy vaccination vary by state. You will likely need to pay for the vaccination upfront. Pharmacies are not legally required to dispense medications without payment.
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.
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Who Is At High Risk For Complications From The Flu
According to the CDC, most people who get the flu will only be mildly ill and will recover without medical care in two weeks or less. However, certain people are at a higher risk for serious complications from the flu virus. If any of these apply to you, you may be at higher risk:
- Individuals under age 2 or age 65 and over
- Residents of nursing homes or long term care facilities
- Pregnant women and women who have recently given birth
- American Indians and Native Alaskans
- People with certain health conditions including asthma, chronic lung or heart disease, neurological disorders, blood disorders, diabetes, diseases of the liver or kidneys, cancer, HIV/AIDS, weakened immune systems, and extreme obesity with a body mass index of 40 or greater
Does A Person With Medicare Get Flu Shots For Free
If a person has Medicare Part B, a Medicare Advantage plan, or private health insurance, they can get a flu shot for free.
The Affordable Care Act requires that insurance companies cover the cost of the flu shot. Plus, under the ACA, insurers cannot charge a copayment, per the Department of Health & Human Services.
A person should check with the site providing the shot to make sure they accept assignment from Medicare or accept Medicare Advantage. People with private insurance should check their plan to make sure they can get the shot from a particular location for free.
Some insurance plans cover the shot only if a person receives it from their doctor. Other plans provide coverage if the shot comes from certain other locations as well.
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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.
Importance Of Flu Shots For Seniors
Americans are living longer than ever before. 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 senior 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 65 and older are more likely than any other age group to be hospitalized for the flu, and approximately nine out of 10 flu deaths in the U.S. occur in seniors, according to the Centers for Disease Control and Prevention .
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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.
When Should You Get Your Flu Shot
Its generally recommended that people get a flu vaccine by the end of October, according to the CDC. This is especially important because of the ongoing spread of COVID-19. The flu season can last until March or April, so you can still get the flu vaccine later. No matter when you get your flu shot, it will still be valuable to help protect you for the rest of the flu season. Talk to your provider about the best time to get your flu shot. Remember to ask about other vaccines you might need to protect yourself this year too.
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Other Preventive Care Covered By Aetna Medicare Advantage Plans
Aetna Medicare Advantage plans can cover a range of additional benefits for preventive care. Coverage can vary, but some Aetna plans may cover:
- Annual wellness visits
- Various screenings and tests for a range of conditions including cancer, cardiovascular disease, depression, diabetes and much more
- Tobacco cessation counseling
Protection From The Flu
The seasonal flu vaccine is available at no cost to Aetna members who have benefits that cover preventive services.
The vaccine is available for adults and for children 6 months and older. Children aged 6 months through age 8 who have never had the vaccine or have only had one dose in their lifetimes should have two doses of the flu vaccine, with at least four weeks between doses.
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How Much Does The Flu Shot Cost
If you have Original Medicare coverage, the flu shot will cost you $0.
If youre wondering where you can get the flu shot, the answer is lots of places, including your doctors office or a local pharmacy. If you have a Medicare Advantage plan, contact the plan provider to find out where exactly you can go for your flu shot. Most places accept Medicare Advantage plans, according to medicare.gov.
Why Get A 2020 Flu Shot
People who are 65 and older are at high risk of having serious health complications from the flu.When people with Medicare get their yearly flu shot, it helps lower the number of medical visits, hospitalizations, and deaths. An essential part of protecting your health during this flu season is getting the flu shot.
This year, due to COVID-19, flu shots are more available than in the past. If youre having trouble finding a place to get your flu shot, find a location near you.
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Do You Need A Flu Shot This Year
According to the Centers for Disease Control and Prevention , people over the age of 65 are at a very high risk of developing dangerous complications from the flu.1 If you are over 65 years old and/or have autoimmune issues , getting your Medicare-covered flu vaccine is your best defense at protecting you from the flu or lessening the effects of it.
Does Blue Cross Blue Shield Ppo Cover Shingles Vaccine
Does Blue Cross Blue Shield Ppo Cover Shingles Vaccine. Find out if a medicare advantage plan or medicare part d plan near you covers the vaccine. The chickenpox vaccine is about 98% effective, and getting the vaccine is much safer than getting the chickenpox disease.
Blue cross and blue shield of illinois wants to help you be protected from illnesses such as the flu, pneumonia, shingles, rabies, hepatitis b, tetanus, diphtheria and pertussis. You may get a flu, pneumonia or shingles shot at any of the participating national retail pharmacy Herpes zoster , two doses for adults 50 years and older or one dose for adults 60 years and older hpv, two or three doses depending on your age when you received your first shot.
Source: antoniosemenec.blogspot.com
The hospital administering the injections should bill blue cross and blue shield of rhode island directly for the drug. Blue cross and blue shield of texas wants to help you protect yourself from illnesses such as the chickenpox, diphtheria, flu, hepatitis a, hepatitis b, hpv, meningitis, pertussis, pneumonia, polio, rotavirus, shingles and tetanus.
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Medicare coverage for shingrix and zostavax, the two. Please note the age for this vaccine is 60 years of age and older based on the cdc/acip
Source: news.ibx.comSource: antoniosemenec.blogspot.comSource: antoniosemenec.blogspot.comSource: www.imedicalexams.comSource: cfisd-connection.blogspot.comSource: www.wichitafallstx.gov
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Who Should Get A Flu Shot
The CDC recommends a yearly flu shot for all adults and children 6 months of age and olderunless you’ve had a severe, life-threatening reaction to a flu shot in the past, which is rare. Talk with your doctor about whether the flu shot is safe for you if you’ve had a severe reaction in the past or are allergic to eggs.
While everyone should get a yearly flu vaccine, it’s especially important if you’re 65 or older because you’re in the age group with the greatest risk for serious complications. Your risk is further increased if you have certain medical conditions, including:
- Asthma or COPD
Does Medicare Cover Shingles Vaccine
Original Medicare doesnt cover shingles vaccines, but that doesnt necessarily mean youll have to pay for it out-of-pocket. The shingles vaccine is required to be one of the vaccines covered by Medicare Part D Prescription Drug plans.
In fact, most vaccines are covered under your prescriptionplan, rather than by Original Medicare. You should check with your specificplan for information such as what your costs will be, which vaccines you canreceive, and where you can go to receive them. Like Original Medicare, some vaccinescovered by Medicare Part D Prescription Drug plans may have eligibilityrestrictions, so be sure to ask your healthcare provider if you qualify.
Being properly vaccinated helps prevent you from catchingavoidable illnesses, and from spreading them to the people around you. Medicarevaccine coverage makes it easy and affordable to stay up to date with yourshots, so you have one less thing to worry about when it comes to your health. Ifyou have questions about eligibility, costs, or whether you should get avaccine, you should consult with your healthcare provider.
Nothing on this website should ever be used as a substitutefor professional medical advice. You should always consult with your medicalprovider regarding diagnosis or treatment for a health condition, includingdecisions about the correct medication for your condition, as well as prior toundertaking any specific exercise or dietary routine.
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Which Shots Are Covered By Original Medicare
Original Medicare consists of two coverage areas: Part A and Part B. Part A covers inpatient hospital stays, and Part B covers certain doctors services, outpatient care, medical supplies, and preventive services.
Part B pays for the flu and pneumonia vaccines, as well as the hepatitis B vaccine for those at increased risk of hepatitis. Medicare Part B also covers vaccines given to treat an injury or direct exposure to a disease or condition, such as rabies and tetanus.
If you have original Medicare you can add drug coverage by joining a Medicare drug plan . Part D plans cover the cost of prescription drugs and many recommended vaccines.
Medicare Advantage Plans May Cover More Vaccines Than Original Medicare
Medicare Advantage plans are sold by private insurance companies as an alternative to Original Medicare.
Every Medicare Advantage plan must provide the same hospital and medical benefits as Medicare Part A and Part B, and most plans include Medicare prescription drug coverage.
MAPDs must help cover a number of commercially available vaccines that arent covered by Original Medicare when reasonably and medically necessary to prevent illness. However, specific rules of administration and costs will vary depending on the Medicare Advantage plan you enroll in.
A licensed insurance agent can help you compare Medicare Advantage plans in your area, including what vaccinations may be covered.
Find Medicare plans that cover your vaccinations
Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!
About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.
Where you’ve seen coverage of Christian’s research and reports:
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What Vaccines Does Medicare Cover
Vaccines can become less effective over time. Even individuals fully vaccinated as children may need to update their immunizations. Medicare Parts B and D offer vaccination coverage.
Medicare Part B covers shots for the flu, hepatitis B, pneumococcal , and COVID-19. Medicare covers 100 percent of the cost of these vaccines if you go to an approved provider, and you do not have to pay a deductible or coinsurance. Medicare Advantage plans are also required to provide these vaccines at no additional costs.
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Medicare covers one flu shot per flu season, which runs from November to April, and not the calendar year. For example, if an individual gets a flu shot in January and again in November of the same year, Medicare would pay for both.
Medicare covers two different pneumonia shots. Medicare recipients can get the first shot at any time and it will cover the second shot if it’s administered at least one year after the first shot.
Hepatitis B shots are free for anyone considered medium or high risk for contracting the virus. End-stage renal disease and diabetes are two conditions that place individuals into a higher risk category. A medical professional can help determine an individuals risk level.
Keeping current on your vaccinations is one of the best ways to prevent serious illness and disease. Talk with your doctor to determine what vaccines you need to minimize risks to your health.
Which Vaccines Does Medicare Cover
Vaccines are important for preventing illness and keeping you well. Because vaccines may get less effective over the years, you may need to talk with your doctor about how frequently you should get certain ones.
Medicare Part B is the part of original Medicare that covers medical costs. It also covers several immunizations. These include:
- hepatitis B vaccines
- influenza vaccine
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