1 Freed M, et al. (Nov 15, 2023). Medicare Advantage 2024 Spotlight: First Look. Kaiser Family Foundation. www.kff.org/medicare/issue-brief/medicare-advantage-2024-spotlight-first-look.
Coverage
Does Medicare Cover Vaccinations?
- January 12, 2024
- Reviewed by John Krahnert
Medicare covers certain vaccinations, including those for COVID-19, influenza (flu), pneumonia and Hepatitis B. Medicare Advantage Prescription Drug plans and Medicare Part D plans cover other vaccines including shots for shingles and whooping cough.
Medicare Part B covers preventive vaccinations that include getting flu shots, pneumonia shots, and COVID-19 vaccinations.
Medicare Advantage (Part C) plans can offer prescription drug coverage, including many commercially available vaccines that Original Medicare (Part A and Part B) doesn’t cover. Medicare Advantage plans that offer drug coverage may not be available where you live.
According to the Kaiser Family Foundation, 89% of Medicare Advantage plans cover prescription drugs in 2024.1
Medicare Part D prescription drug plans and Medicare Advantage plans that include prescription drug coverage are not allowed to charge coinsurance costs or apply a deductible for vaccines recommended by the Advisory Committee on Immunization Practices.
Learn about the Medicare Advantage plan options where you live. Compare plans online or call to speak with a licensed insurance agent who can help you find out if plans in your area cover prescription drugs like vaccines.
We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.
What vaccines are covered by Medicare?
The following chart shows how some common vaccines are covered by Medicare Part B.
All Medicare Advantage plans are required to cover the same benefits as Part B.
Medicare Advantage plans will cover vaccinations covered by Medicare Parts A and B. Medicare Advantage plans that include prescription drug coverage can also cover other vaccines not covered by Original Medicare.
| Vaccine | Medicare costs |
|---|---|
| Coronavirus 2019 (COVID-19) | You pay no Part B coinsurance or deductible costs, as long as the government continues buying and distributing the vaccine |
| Influenza (flu shots) | You pay no Part B coinsurance or deductible costs for one flu shot per flu season if your doctor accepts Medicare assignment. |
| Pneumococcal (pneumonia) | You pay no Part B coinsurance or deductible costs for two pneumonia shots (the first at any time, the second at least one year after the first shot) if your doctor accepts Medicare assignment. |
| Hepatitis B | You pay no Part B coinsurance or deductible costs for the Hepatitis B vaccine if you’re at medium or high risk for Hepatitis B and your doctor accepts Medicare assignment. |
These are only a few common vaccines. Check with your doctor or health care provider if you have questions about a specific immunization or vaccine that is not listed here.
Does Medicare pay for Tdap immunizations?
Medicare Part B does not typically cover Tdap, which is the adult booster shot for tetanus, diphtheria and pertussis (whooping cough).
Many Medicare Advantage Prescription Drug plans (MAPD) and standalone Medicare Part D prescription drug plans (PDP) cover Tdap.
Does Medicare cover the Hepatitis B vaccine?
Medicare Part B and Medicare Advantage plans will cover injection of the Hepatitis B vaccine if you are considered at medium or high risk for Hepatitis B.
You may have an increased risk if:
- You have hemophilia
- You have End-Stage Renal Disease (ESRD)
- You have diabetes
- You live with another person who has Hepatitis B
- You work in health care and have frequent contact with blood and other bodily fluids
Your doctor can help you determine if you’re at increased risk for contracting Hepatitis B.
Does Medicare cover pneumonia shots?
Medicare Part B typically covers pneumonia (pneumococcal) shots, which help prevent certain types of pneumonia. Medicare Advantage Prescription Drug plans also cover pneumonia shots.
Medicare typically covers 100 percent of the Medicare-approved amount of your pneumococcal vaccine (if you receive the service from a provider who participates in Medicare).
Before getting your pneumonia shot, verify with your doctor that it is 100 percent covered by Medicare.
The Centers for Disease Control and Prevention (CDC) recommends PPSV23 pneumococcal vaccinations for all adults who are 65 years of age or older. Talk to your health care provider to learn more.
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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.
Specific details of Medicare Advantage plans such as their costs (including monthly premiums, deductibles and coinsurance) and coverage limitations will vary.
A licensed insurance agent can help you compare Medicare Advantage plans in your area, including whether any plans that offer prescription drug coverage are available where you live and the vaccinations they cover.
We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
