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Medicare Immunization Coverage | Trusted Senior Specialists

The coverage of Preventive Care is one of the most vital parts of Medicare’s role in keeping beneficiaries healthy. Preventive Care is care that you receive to prevent illness, help detect medical conditions, and to keep you healthy. Medicare Part B covers many preventative services, such as screenings, vaccines, and counseling. If you meet the eligibility requirements and guidelines for preventative service, you must be allowed that service. This is true for both Original Medicare and Medicare Advantage Plans (MA), however, coverage rules may apply. 

Vaccines are a key component to helping you avoid diseases that can prevent you from aging well. Whether reinforcing the immunizations you received as a child or preparing you for the upcoming flu season, you should have a discussion with your doctor about the four vaccines Medicare helps to pay for in order to play a proactive role with your health.

Influenza Vaccine

  • Influenza, or the flu, is a contagious respiratory illness that can be severe and life-threatening.
  • Older adults, even if you are healthy, you could be at higher risk when it comes to the flu due to age-related weakening of our immune systems, making it more difficult for us to fight off disease. For 86% of adults 65+ who are managing a chronic condition, such as heart disease or diabetes, the flu can be even more dangerous because you are more likely to develop complications or become hospitalized. Flu combined with pneumonia, a common acute condition among the aging population, is one of the top 10 causes of death for those aged 65 and older in the U.S. 
  • According to the Centers for Disease Control and Prevention (CDC), the flu vaccination is the best way to prevent the flu. To address the increased risks faced by an aging population, a higher-dose version of the flu vaccine was created specifically for older adults.
  • The flu vaccine is once a year, cost-free Medicare B benefit. For Original Medicare, you must use a physician or healthcare provider who accepts Medicare assignment, and for Medicare Advantage, you may have to use an in-network doctor or pharmacy.

Pneumococcal Vaccine

  • Pneumococcal disease causes severe infections throughout the bloodstream and/or key organs. Some of the conditions that can result from this disease are pneumonia (infection of the lungs), meningitis (infection of the lining of the brain and spinal cord), and bacteremia (infection of the bloodstream). Pneumococcal disease can result in deafness, brain damage, loss of limbs, and even death.
  • Why is it important for older adults to get the pneumococcal vaccine? Pneumococcal disease kills 18,000 adults 65+ each year. A weakening immune system means that older adults are at greater risk, and can face more severe side effects, especially for those who are managing chronic diseases.
  • The pneumococcal vaccine is a cost-free benefit covered by Medicare Part B. For Original Medicare, you must use a physician or healthcare provider who accepts Medicare assignment, and for Medicare Advantage, you may have to use an in-network doctor or pharmacy.

Shingles Vaccine

  • Shingles is a painful skin rash that’s caused by the same virus responsible for chickenpox. Shingles are less contagious than chickenpox and can only be passed on to another person up to the point when the infected person’s blisters begin to scab. Even after shingles passes, long-term pain can linger.
  • Researchers believe that the age-related weakening of our immune systems can trigger the “reawakening” of the dormant chickenpox virus. One in three adults contracts shingles at some point in their life, most cases being those who are 60 years of age or older. The older you are when you get shingles, the more likely you are to have severe side effects, such as fever, exhaustion, and loss of appetite. These can lead to malnutrition, physical deterioration, and/or additional infections. Whether you had chickenpox as a child or not, you should still talk to your doctor about getting vaccinated.
  • All Medicare Part D drug plans, or Medicare Advantage plans that include prescription coverage, typically cover the shingles vaccine. However, there is generally an out-of-pocket cost. Depending on your plan, you will either be responsible for a copayment (a fixed dollar amount) or coinsurance (percentage of the vaccine’s cost). You are likely to have the least out-of-pocket expenses if you use a pharmacy in your plan’s network. Each plan has specific rules for covering the vaccine itself, as well as the administration of the injection, so it’s best to contact your insurance company directly to find out your specific out-of-pocket cost, and any rules you must follow regarding where you receive the vaccine.

Hepatitis B Vaccine

  • Hepatitis B is a contagious virus that infects the liver. Acute Hepatitis B, which usually lasts a few weeks, often mimics symptoms similar to the flu and could cause fever and nausea. Chronic Hepatitis  B is long-term and often has no symptoms at all, but can cause liver damage or death.
  • The liver and its function change as we age, making Hepatitis B more prevalent among older adults. Your risk of contracting Hepatitis B increases if you have hemophilia, end-stage renal disease (ESRD), diabetes, or other conditions that lower your resistance to infection. Acute Hepatitis B is particularly dangerous for older adults because there is no specific treatment for the symptoms.
  • Medicare Part B insurance covers the full cost of the Hepatitis B vaccine(s) if a doctor determines that you are at a high risk of contracting the Hepatitis B virus, and the physician or healthcare provider administering the vaccine accepts Medicare assignment. A consultation with your doctor can help you determine your risk of contracting Hepatitis B. 

Making the most of your Medicare Coverage:

Getting vaccines is an integral part of ensuring you maintain your health as you get older, and they can also safeguard the health of your family and friends. If you know someone who may not be vaccinated, share this important information with them so they can take the steps towards protecting themselves. 

Give your doctor a call today to see if these vaccines can help you. Then, check with your Medicare provider about where you can get these vaccinations, and be sure to ask what your expected out of pocket costs will be. 

Original Medicare covers many preventive screenings and tests at no cost. By law, Medicare Advantage plans must also provide the same preventions. There is no need to allow a chronic disease to take over your health with so many great free preventive services covered by Medicare and its plans. Call us if you want to know what other preventive screenings and tests are available!


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