Does Medicare cover all of my vaccines?
Not all vaccines or shots are covered by your Medicare plan. Get to know what’s covered, so you don’t end up with a surprise bill.
Even though they seem the same – you get stuck by a needle! – not all shots and vaccines are covered equally under your Medicare plan. A lot of members call in when they get a bill for a shot they thought was covered by their Medicare plan and are confused why they’re being asked to pay the full amount.
The short story is, some shots and vaccines are covered by your medical coverage (called Medicare Part B, or coverage you have through a private insurance company), while others are covered by Medicare plans that offer prescription drug coverage (called Part D). Before you get that poke, check with your insurance company to see if it’s covered by your plan and how much it may cost you.
Not sure what type of Medicare plan you have? Find out how to check at the bottom of this post.
Related content: Is it covered? How to know before you pick a Medicare plan
Your medical coverage
If you have Original Medicare Parts A and B, which is hospital and medical coverage provided by the federal government, or a Medicare plan from a private insurance company, this medical coverage takes care of vaccines for the flu, pneumonia and, if you are at risk, hepatitis B (learn who is at risk here).
Your plan will only cover some vaccines if you need them because you’ve been put in danger of getting a disease or illness – like if you’re bitten by a dog and need rabies shots.
- If you have Original Medicare, check if your vaccine is covered here
- If you have insurance through a private insurance company, call them to see if your vaccine is covered, or check your online web account, if you have one
Your prescription drug coverage
Some vaccines are covered under your prescription drug coverage (Part D), if you have it. Typically, prescription drug coverage is offered by a private company in addition to a medical plan. If you don’t have prescription drug coverage, you might have to pay full price for the other vaccines you need or want. For example, your prescription drug coverage will likely help you pay for a shingles vaccine; if you don’t have this type of plan coverage, you’ll have to pay for it out of pocket.
If your doctor recommends you get a vaccine, check first with your insurance company to see:
- If the vaccine is covered
- If the vaccine is covered under your medical coverage or prescription drug coverage
- If it’s affordable for you. Your insurance may not cover the entire cost
Knowing whether it’ll be covered under your medical or prescription drug benefit can help you estimate how much you’ll be responsible for paying. Remember, always call your member services team with any questions!