INDIANA — Navigating Medicare benefits can raise important questions for older adults and individuals with disabilities, especially regarding which vaccines are covered and how out-of-pocket costs are handled.
According to guidance from the State Health Insurance Assistance Program (SHIP), many essential vaccines are covered under Medicare Part B or Medicare Part D. However, specific eligibility criteria—such as age, underlying risk factors, and recommended dosing intervals—determine how coverage is applied.
Vaccines Covered Under Medicare Part B (No Copays or Deductibles)
Under Medicare Part B, several routine and preventive vaccines are classified as free benefits, meaning beneficiaries face zero out-of-pocket costs, copayments, or deductibles:
- COVID-19: Coverage for COVID-19 immunizations remains fully intact under Part B, even following the conclusion of the public health emergency.
- Annual Flu Shot: Fully covered as an annual preventive measure, typically administered ahead of peak flu season.
- Pneumonia: Covered to protect against severe pneumococcal infections. Depending on medical guidelines, Part B covers either a single-dose vaccine or a two-dose series spaced at least one year apart for most adults aged 65 and older.
- Hepatitis B: Covered as a preventive benefit for individuals assessed at medium or high risk for contracting the virus.
- Tetanus (Treatment-Related): Covered by Part B if administered as medical treatment following an acute injury, such as a severe cut or wound.
Vaccines Covered Under Medicare Part D Prescription Plans
Other preventive vaccines are covered through standalone Medicare Part D prescription plans or Medicare Advantage plans with drug coverage. Beneficiaries enrolled in these plans may be subject to plan deductibles or copayments depending on their specific policy:
- Shingles: Recommended by the CDC for adults 50 and older. Coverage applies to the two-dose Shingrix series, spaced two to six months apart.
- RSV (Respiratory Syncytial Virus): FDA-approved for adults aged 60 and older to protect against severe respiratory complications, which can aggravate conditions like asthma or COPD.
- Tdap (Tetanus, Diphtheria, Pertussis): Covered for routine preventive care, with the CDC recommending a Tdap or Td booster every 10 years. Routine tetanus boosters for preventive maintenance fall under Part D rather than Part B.
- Hepatitis A & Low-Risk Hepatitis B: Covered under Part D for individuals recommended by the CDC to receive Hepatitis A protection, as well as Hepatitis B shots for individuals determined to be at low risk.
Tracking Benefits and Getting Help
Medicare beneficiaries can monitor their personal preventive care schedule and track covered immunizations by logging into their account at Medicare.gov.
For free, impartial counseling regarding Medicare options and coverage details, Indiana residents can contact SHIP at 800-452-4800 or visit Medicare.in.gov.
