With the COVID-19 Omicron variant spreading like wildfire, those on medicare have lots of questions about which vaccines are covered and which vaccines are not covered.
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 (pneumonia), 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.
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 individual’s risk level.
Medicare Part D plans (as well as Medicare Advantage plans with built-in Part D) should cover all other commercially available vaccines, including shingles and Tdap (tetanus, diphtheria, and pertussis), when they are reasonable and necessary to prevent illness. Contact your Part D plan to make sure it covers the shot you need. To limit your copay, you should go through an in-network provider that will either handle billing your Part D plan electronically or coordinate this with a pharmacy.
Ask your vaccine provider if it can bill your Part D plan directly. If your doctor or pharmacy can’t do this, the provider will have to bill you for the entire cost of the vaccination and you’ll have to request reimbursement from your plan. And note that the plan will reimburse for only the approved amount, which may be less than what the provider charged you.
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.
For more from the Medicare Rights Center on Medicare’s vaccination coverage, click here.
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