Which Vaccines Does Medicare Cover

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If you're covered by original Medicare or a Medicare Advantage plan, you typically can get a vaccine without any cost-sharing. In other words, most vaccines are covered by your Medicare plan without any out-of-pocket costs.

Let's talk more about how this happened, as well as coverage specifics.

No out-of-pocket costs for people with insurance

Most adults who have insurance pay nothing for most vaccines. That's because the Affordable Care Act (ACA, also known as Obamacare) and the Inflation Reduction Act of 2022 don't allow you to be charged out-of-pocket costs for certain vaccines if you're covered by:

• Medicare Part B

• Medicare Part D prescription plans (which cover most vaccines for Medicare enrollees)

• Most commercial insurance plans

• Medicaid

With health insurance, you will not have cost-sharing for vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). Those vaccines protect you against:

• Anthrax

• Cholera

• COVID-19

• Dengue

• DTaP-IPV-Hib-HepB, a combination of diphtheria, tetanus, pertussis (whooping cough), inactivated polio virus, Haemophilus influenzae, and hepatitis B

• DTaP/Tdap/Td, a combination of diphtheria, tetanus, and pertussis

• Ebola

• Hepatitis A

• Hepatitis B

• Hib

• HPV

• Influenza

• Japanese encephalitis

• Measles, mumps, and rubella (MMR)

• Measles, mumps, rubella, and varicella (MMRV)

• Meningococcal

• Orthopoxviruses (smallpox and Mpox)

• Pneumococcal (pneumococcal)

• Polio

• Rabies

• Rotavirus

• Respiratory syncytial virus (RSV)

• Tick-borne encephalitis

• Typhoid

• Varicella (chickenpox)

• Yellow fever

• Zoster (shingles)

Some vaccine categories above, such as shingles, have just one FDA-approved vaccine (Shingrix) in the U.S., while COVID and influenza (flu) each have multiple vaccines available.

Which vaccines are covered by Medicare?

As mentioned, most vaccines are covered by Medicare. What may be tricky is understanding what part of Medicare covers a particular vaccine. Depending on the vaccine, you may be covered by:

• Medicare Part B: This is the part of original Medicare that covers outpatient services, as well as some medications and vaccinations.

• Medicare Part D: This part of Medicare covers most prescriptions and vaccinations. If you have original Medicare (Part A and/or Part B), you will need a standalone Part D prescription plan. Most Medicare Advantage plans include Part D coverage.

• Medicare Advantage: These private plans replace original Medicare with equal or superior benefits, though there are drawbacks. If Part D isn't included in your Medicare Advantage plan, you can buy a standalone Part D plan for prescription coverage.

Which vaccines are covered by Medicare Part B?

Some vaccines recommended by ACIP and covered by Medicare fall under Part B. Some of the most common vaccines that Part B covers include:

• COVID

• Flu

• Hepatitis B (for individuals at high and intermediate risk)

• Pneumonia (pneumococcal)

It's important to note that Part B also covers vaccines that treat an injury or exposure to disease. For instance, Part B should cover your tetanus shot if you step on a rusty nail and your healthcare professional recommends this vaccine. The same goes for a preventive rabies shot following a dog bite. But, if you get a tetanus booster shot not related to injury or illness, that's covered by Part D.

Which vaccines are covered by Medicare Part D?

Part D typically covers vaccines that are not covered under Part B. There is no cost-sharing with covered vaccines, even if you get the vaccine from a healthcare professional who is outside of your plan's network. You also don't have to pay for vaccine administration. (If you are charged a vaccine administration fee by an out-of-network vaccine provider, you can get reimbursed by your Part D plan.)

The vaccines covered under Part D include:

• Anthrax

• Cholera

• Dengue

• DTaP-IPV-Hib-HepB

• DTaP/Tdap/Td

• Ebola

• Hepatitis A

• Hib

• HPV

• Japanese encephalitis

• MMR

• MMRV

• Meningococcal

• Orthopoxviruses (smallpox and Mpox)

• Polio

• Rotavirus

• RSV

• Tick-borne encephalitis

• Typhoid

• Varicella (chickenpox)

• Yellow fever

• Zoster (shingles)

Which vaccines are covered by Medicare Advantage?

All vaccines covered by Medicare Part B and Part D are covered by Medicare Advantage plans that include prescription coverage. You are also covered fully if you have a Medicare Advantage plan without Part D coverage and have purchased a standalone Part D plan.

Which vaccines are NOT covered by Medicare?

While most vaccines are covered with no cost-sharing for Medicare enrollees with Part B and Part D coverage, there are times you could find yourself paying out-of-pocket costs. These scenarios include:

• If you need a vaccine while traveling abroad, you might need to pay for those shots yourself.Medicare typically doesn't cover health costs for enrollees who are traveling outside the U.S., though there are exceptions. If you have original Medicare, some Medigap plans offer limited benefits when you're traveling abroad.

• If you have Medicare without a Part D plan, you will be responsible for paying for vaccines covered under Part D.

• Vaccines no longer authorized for use or available in the U.S., such as the Johnson & Johnson (J&J) COVID vaccine.

Frequently asked questions

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