What vaccines does medicare part d cover

Medicare prescription drug coverage (Part D) usually covers all commercially available vaccines needed to prevent illness, including the Tdap shot. Contact your Medicare drug plan for more coverage information.

If you’re on Medicare, your coverage includes influenza (flu), pneumococcal (pneumonia), and often hepatitis B vaccines at no cost under Part B.

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While there is a lot of focus on the COVID-19 vaccine, it’s important to remember that Medicare covers other important immunizations. Some shots are covered under Medicare Part B, while others are covered by your Part D or Medicare Advantage plan. 

For example, vaccines that help prevent the flu and pneumonia are fully covered under Medicare Part B, along with hepatitis B for those at a higher risk of illness. Your Part D or Medicare Advantage plan (Part C) may also pick up the cost of vaccines that protect against illnesses such as shingles. 

“During the [pandemic] lockdown, routine vaccines have dipped substantially. It’s important to catch up on immunizations that were missed,” Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center, tells GoodRx. 

Below, we’ll go over which vaccines Medicare covers and ways you can save. 

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 some vaccines and a variety of outpatient services and supplies, including:

• Healthcare provider visits, outpatient care, and ambulance transport

• Medical equipment such as blood sugar meters, walkers, and wheelchairs

• Preventive services like mammograms, prostate cancer screenings, and immunizations

Which vaccines are covered under all Medicare plans?

If you have original Medicare, you can add medication coverage by joining a Medicare prescription medication plan (Part D). Generally, Medicare Part D covers all vaccines not covered by Part B that are “reasonable and necessary” to prevent illness. Medicare Part B covers vaccines given to treat an injury or direct exposure to a disease or condition, such as rabies, tetanus, flu, and pneumonia. 

Medicare Advantage (MA) plans, sometimes referred to as Part C plans, are offered by private insurers for a set monthly premium. These plans bundle Part A and Part B insurance and usually Part D coverage. MA plans have to provide coverage that’s equal to original Medicare, with some added extra benefits like dental and vision care, but rules and costs may be different. Unlike original Medicare, you generally have to visit a healthcare provider or pharmacy in your MA plan’s network. Vaccines covered by Part D or Medicare Advantage may have co-pays or out-of-pocket costs. 

Check with your insurance provider for specific plan details. 

Avoiding vaccines can have serious health consequences. Since you can easily get vaccines at your provider’s office or the pharmacy, making them a priority is worthwhile. 

Does Medicare cover flu shots? 

The short answer? Yes, Medicare does cover flu shots. If you have original Medicare, Part B covers your annual flu shot at no out-of-pocket cost to you.

If you have a Medicare Advantage plan, contact your plan for more information. Many places that offer flu shots also accept Medicare Advantage Plans.

Does Medicare cover shingles shots?

The CDC recommends adults 50 years and older should get two doses of the shingles (Shingrix) vaccine. Shingles is a viral infection that can cause several symptoms, including:

• Nerve pain

• Rash and blisters

• Eye problems

• Pneumonia

Two doses of Shingrix will protect you against shingles and postherpetic neuralgia (PHN), the most common shingles complication. PHN affects your nerve fibers and skin, leading to burning pain that persists after other symptoms of shingles, such as the rash and blisters, have gone away.

Studies suggest Shingrix was between 91% and 97% effective in preventing shingles after two shots, depending on age. Since your risk of getting shingles and PHN increases as you get older, strong protection against shingles after 50 is important.

Most Medicare Part D plans cover shingles shots, as well as Medicare Advantage plans with built-in Part D coverage. Depending on your plan, you may have to pay:

• Toward your deductible

• A copay

• Out-of-pocket and get reimbursed later. 

If you haven’t met your plan’s deductible for the year, you’ll have to pay full price for the vaccines. If you have to pay upfront, the average retail cost of Shingrix is a little over $200 per dose. You need two doses of Shingrix, 2 to 6 months apart.

You may also qualify for Extra Help, a Medicare program that helps pay for prescription medication program costs, such as premiums, deductibles, and coinsurance. If you’re not eligible for Medicare and don’t have a plan that covers Shingrix, you can pay as low as $155 with a GoodRx coupon.

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Which vaccines should older adults get and when? 

The CDC has established a vaccination schedule for adults over 65. Other factors, such as your health conditions and medical history, may affect these recommendations. Check with your healthcare provider about which vaccines you’ll need and which shots will be covered under the Medicare plan you have. 

A typical vaccine schedule for older adults breaks down like this:

• Pneumococcal (pneumonia) vaccine: The CDC recommends a single shot of the pneumonia vaccine to those who need it. People with certain chronic medical conditions, such as chronic heart or lung disease, may need one or two additional shots. This is covered under Medicare Part B. 

• Flu vaccine: The flu shot is usually available in early fall, before flu season starts. Every year, adults 65 and older should get the flu shot, not a nasal spray vaccine. The CDC also recommends older adults receive the high-dose quadrivalent flu vaccine. This is covered under Medicare Part B. 

• Shingles vaccine: The CDC recommends you get two doses of the shingles vaccine Shingrix, 2 to 6 months apart. If you received a different shingles vaccine called Zostavax in the past, you still need the Shingrix vaccine. Zostavax is no longer in use in the U.S. This is typically covered by Medicare Advantage or Part D plans. 

• Tetanus, diphtheria, and pertussis (Tdap): The CDC recommends adults 65 and older should receive the Tdap vaccine if they’ve never had it before, followed by a booster every 10 years. If you need the shot as part of wound management (to prevent tetanus), one dose is recommended. This is covered by Medicare Advantage or Part D plans. 

If you’re over 65 and have additional risk factors, you may also need these vaccines:

• Hepatitis A

• Hepatitis B

• Meningococcal A, C, W, Y (meningitis) 

• Varicella (chicken pox)

The CDC also recommends that adults 65 and over should receive the COVID-19 vaccine, since the risk of severe illness increases with age. The COVID-19 vaccine is free to everyone ages 5 and older who wants one. There are several different COVID-19 vaccines available. It is not yet known how long protection lasts.

Is it cheaper to get a vaccine at my doctor’s office or a pharmacy?

You may feel more comfortable getting shots at your healthcare provider’s office. Your provider knows your patient history and can provide a one-on-one experience. If you choose to get vaccinated at your provider’s office, keep in mind you may be billed for an office visit in addition to the cost of the shot. 

You can also get immunizations against flu, pneumonia, shingles, and other conditions at your local pharmacy. You’ll be responsible for any copays or deductibles depending on your prescription medication plan, but you won’t have an office visit copay. 

Plus, your vaccine record will be kept on file as part of your permanent pharmacy history. “When you get vaccinated at your pharmacy, your information is entered into the state immunization registry, which can be accessed by your doctor,” Dr. Schaffner says.

For the COVID-19 vaccine, your provider shouldn’t charge you if the vaccine was the only service you received. You should ask for a refund if you believe you were billed in error for the COVID-19 vaccine.

The bottom line

Make the most of your Medicare coverage and protect your health by getting the vaccines you need. Getting the COVID-19 vaccine should be a priority, but you still need to keep up with other shots recommended by the CDC. If you’re an older adult, you should plan on getting the flu shot every fall and two doses of Shingrix to prevent shingles. Talk to your healthcare provider to determine if you need other vaccines such as pneumonia or Tdap. Check your insurance plan to see what’s covered. GoodRx also offers discounts on vaccines to help you save.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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