August marks National Immunization Awareness Month, an annual observance designed to highlight the importance of vaccinations and encourage people of all ages to stay up to date on their immunizations. The immunizations a person requires vary based on age, medical history and other conditions, and levels of risk and exposure.
How Medicare Covers Vaccines
Medicare covers vaccinations as preventive care under both Part B and Part D, depending on the type of immunization or exposure. Most vaccines are covered under Part D, and Part D plans must include most commercially available vaccines on their formularies. The only vaccines covered by Part B are for the flu (both the seasonal flu and H1N1 vaccines), pneumonia, Hepatitis B, and COVID-19. Part B also covers vaccines as treatment for acute exposure, such as for the tetanus shot after stepping on a rusty nail (whereas a regular tetanus booster would be covered by Part D).
To avoid billing issues and surprise costs, contact your health care provider or pharmacy in advance to make sure that they can bill your Part D plan directly.
To avoid billing issues and surprise costs, contact your health care provider or pharmacy in advance to make sure that they can bill your Part D plan directly. If a vaccine is new and has not yet been added to your plan’s formulary, you or a representative can request coverage through a formulary exception request.
Recent Policies Affecting Vaccine Coverage
Beginning in 2023, all vaccines covered under Part D became free for beneficiaries due to the prescription drug provisions of the Inflation Reduction Act. As a result, the routine shingles, Tdap (tetanus, diphtheria, and pertussis), and RSV (respiratory syncytial virus) vaccines all became newly cost-free for people enrolled in Medicare Part D.
Earlier this year, the Supreme Court’s ruling in Kennedy v. Braidwood Management preserved access to no-cost preventive services according to Affordable Care Act (ACA) requirements. The decision, which affirmed the authority of the U.S. Preventive Services Task Force (USPSTF) to make recommendations about what services ACA plans must cover, allowed immunization coverage to continue unchanged.
The skepticism against and politicization of scientific expertise continue to pose threats to vaccine access and research.
However, the skepticism against and politicization of scientific expertise—from which the arguments against the authority of the USPSTF sprang—continue to pose threats to vaccine access and research. Affordable access to immunizations, especially for older adults, is crucial for lowering barriers to necessary care and improving long-term health outcomes.
This National Immunization Awareness Month, Medicare Rights encourages members of the community to learn about their vaccine eligibility and stay up to date on their immunizations.
Visit Medicare Interactive to learn more about Medicare coverage of vaccines and immunizations.
