August is National Immunization Awareness Month (NIAM), a time to talk about the importance of vaccination for people of all ages. Most of us received vaccinations as children. As adults, we still need to keep up to date. The Centers for Disease Control and Prevention (CDC) says all adults need the influenza (flu) vaccine each year plus the Tdap vaccine. In addition, you may need other vaccines based on other factors such as age, health conditions, job, lifestyle or travel habits. It’s important to have conversations with your healthcare provider about vaccines and which are right for you.
As you approach the age of 65, or if you are 65+, you might wonder what vaccines you need and if they are covered. We can answer a few common questions you might have.
What vaccines does Original Medicare (Parts A and B) cover?
Medicare Part B covers vaccines directly related to treatment of an injury or direct exposure to a disease or condition, such as rabies and tetanus. In addition, Medicare Part B covers two different pneumococcal vaccines. The first is covered at any time, and a different, second vaccine is covered if it is given at least one year after the first. Medicare Part B also covers one influenza (flu) vaccine per season and hepatitis B vaccines if you are at medium or high risk. Note that Medicare Part B does not cover the shingles or Tdap vaccine.
What vaccines do Medicare Part D plans cover?
If you opt for Original Medicare, you can also choose to purchase prescription drug coverage, known as Medicare Part D, provided by a private insurance company. Usually, Medicare Part D plans will cover vaccines that are commercially available such as MMR, shingles and Tdap. You can identify covered vaccines by looking at your list of covered drugs (formulary). To find out more, contact your Medicare drug plan directly.
What vaccines do Medicare Advantage plans cover?
A Medicare Advantage plan covers all immunization services that are included under Medicare Part B. A lot of Medicare Advantage plans also include Medicare Part D prescription drug coverage. These plans are known as MAPD plans. MAPD plans will typically cover additional vaccines such as MMR, shingles and Tdap. You can identify covered vaccines by looking at your “Drug List” (formulary). To find out more, contact your Medicare Advantage plan directly.
Medicare Advantage plans offered by Aspire Health Plan are all MAPD plans. There is no coinsurance, copayment, or deductible for the pneumonia, influenza (flu), and hepatitis B vaccines. We also cover other vaccines if you are at risk and they meet Medicare Part B coverage rules. We also cover some vaccines under our Part D prescription drug benefit.
We recommend that you call us at Member Services if you are unsure.
Rules of coverage for vaccinations can be a bit complicated. Always remember that we’re here to help. If you are planning on getting a vaccination, give Member Services a call at (855) 570-1600 (TTY users call 711). We can tell you how your vaccination is covered by our plan, explain your share of the cost, and tell you how to keep your cost down.
What are the changes of 2021 vs 2020? Thank you!
Hi Lance! Coverage for immunizations with Medicare (and with Aspire Health Plan’s Medicare Advantage plans) have not changed from 2020-21.