Vaccines Covered by Medicare

Medicare covers some, not all, of the vaccines recommended by the Centers for Disease Control’s Advisory Committee on Immunization Practices (ACIP). While Medicare Part B (part of Original Medicare) covers some vaccines, others are covered under Medicare Part D. Medicare Part D is not included in Original Medicare.

In 2023, additional vaccines will be fully covered by some Medicare plans.

Medicare Part B covers several vaccines that play a vital role in preventing disease and maintaining health. These vaccines and other preventive services are available to you at no cost.

Other vaccines, like a tetanus or rabies shot, are covered by Medicare Part B if they are related to a doctor’s treatment of an injury or illness.

Certain vaccines that are not under Medicare Part B coverage can be paid for through your Medicare Part D plan.

Medicare Part D, the prescription drug plan, pays for commercially available vaccines not covered by Medicare Part B.

According to the Centers for Medicare and Medicaid Services, a medical professional must deem the shot reasonable and necessary to prevent illness, and your co-pays will vary according to your particular plan.

Part D plans use a formulary, a list of drugs and shots, to indicate exactly which measures are covered by each plan. Formularies are designed to meet the needs of most members. However, your plan may still cover certain new vaccines, even if they do not appear in the formulary.

Part D plans often have special rules for vaccines, such as needing prior authorization from your doctor or quantity limits. Contact your plan provider for your specific coverage details.

Medicare Advantage (Part C) plans that include prescription drug coverage usually also cover all commercially available vaccinations.

Starting in Jan. 2023, immunizations recommended by ACIP, including the shingles and Tdap vaccines, will be covered by Medicare Part D with no deductible and no copay, as part of the Inflation Reduction Act.

Otherwise, how much you pay for Part D shots can vary depending on your plan and where you get vaccinated.

You can receive vaccinations at an in-network pharmacy or your doctor’s office. Your doctor can also coordinate with your pharmacy to directly bill your Part D plan for the vaccination, so you will only owe your plan’s coinsurance or copay.

Make sure to check your plan’s coverage rules to find the most affordable place to get vaccinated

Not all medical providers can administer every vaccine. Your state or local health department should offer a list of providers near you if you don’t have a primary care physician or nearby pharmacy.

Your local pharmacy will often be able to provide vaccinations if they accept Medicare. Your primary health physician or clinic is another excellent choice.

Some vaccines require a doctor’s prescription; others will be available without one.

The goal of vaccination is prevention. As you age, childhood vaccines lose their efficacy and new health concerns arise. Even if you are healthy, it is important to keep up with medically recommended vaccinations. This could save you time and money in the future.

The Centers for Disease Control and Prevention (CDC) has an updated list of recommended vaccines for adults. In addition to COVID-19 and annual flu shots, the CDC encourages adults over 50 to get shingles and pneumococcal vaccines, as well as a Tdap booster. They also recommend the Hepatitis B vaccine for adults aged 60 and up, especially if you have risk factors for the disease.

Editor Samantha Connell contributed to this article