What vaccines does Medicare cover?

What vaccines does Medicare Part D cover?

Unless Part B covers a vaccine, Part D plan formularies usually cover all commercially available inoculations to prevent illness. These include:

Hepatitis A. The CDC recommends a hepatitis A shot for children age 12 to 23 months and children age 2 to 18 who weren’t vaccinated earlier. It also recommends the vaccine for adults at increased risk for hepatitis A, including people with chronic liver disease or those who have HIV or work in areas with a risk of infection as well as others at high risk. 

Hepatitis B. For those at low risk for hepatitis B.  

RSV. Respiratory syncytial virus can lead to pneumonia or bronchiolitis and can worsen other chronic conditions common among older adults, such as asthma and chronic obstructive pulmonary disease (COPD). In 2023, the Food and Drug Administration approved the RSV vaccine for adults 60 and older to help protect against contracting the virus.

On June 26, 2024, the CDC recommended that people age 75 or older who haven’t received an RSV vaccine should get one later this summer or early fall. It also recommended the vaccine for people ages 60 to 74 who are at high risk for severe RSV because they have chronic health conditions, such as heart or lung disease, or live in a nursing home. The RSV vaccine is not currently an annual vaccine.

Shingles. The CDC recommends that everyone 50 or older get the shingles vaccine. It recommends two doses of Shingrix spaced two to six months apart, even if you previously received Zostavax. In 2020, Shingrix replaced Zostavax, which is no longer available in the U.S.

Tdap. This shot protects against tetanus, diphtheria and whooping cough, also known as pertussis. The CDC recommends getting a Tdap or Td booster every 10 years. 

Even some less-common shots. These include immunizations you may need for travel to Africa, Asia, Central and South America, and the Pacific Islands, which are usually covered through Part D without deductibles or copayments if the CDC recommends them for your travel.

What vaccines does Medicare Part D cover?

Unless Part B covers a vaccine, Part D plan formularies usually cover all commercially available inoculations to prevent illness. These include:

Hepatitis A. The CDC recommends a hepatitis A shot for children age 12 to 23 months and children age 2 to 18 who weren’t vaccinated earlier. It also recommends the vaccine for adults at increased risk for hepatitis A, including people with chronic liver disease or those who have HIV or work in areas with a risk of infection as well as others at high risk. 

Hepatitis B. For those at low risk for hepatitis B.  

RSV. Respiratory syncytial virus can lead to pneumonia or bronchiolitis and can worsen other chronic conditions common among older adults, such as asthma and chronic obstructive pulmonary disease (COPD). In 2023, the Food and Drug Administration approved the RSV vaccine for adults 60 and older to help protect against contracting the virus.

On June 26, 2024, the CDC recommended that people age 75 or older who haven’t received an RSV vaccine should get one later this summer or early fall. It also recommended the vaccine for people ages 60 to 74 who are at high risk for severe RSV because they have chronic health conditions, such as heart or lung disease, or live in a nursing home. The RSV vaccine is not currently an annual vaccine.

Shingles. The CDC recommends that everyone 50 or older get the shingles vaccine. It recommends two doses of Shingrix spaced two to six months apart, even if you previously received Zostavax. In 2020, Shingrix replaced Zostavax, which is no longer available in the U.S.

Tdap. This shot protects against tetanus, diphtheria and whooping cough, also known as pertussis. The CDC recommends getting a Tdap or Td booster every 10 years. 

Even some less-common shots. These include immunizations you may need for travel to Africa, Asia, Central and South America, and the Pacific Islands, which are usually covered through Part D without deductibles or copayments if the CDC recommends them for your travel.

How does the change in law affect me?

Before the Inflation Reduction Act eliminated all out-of-pocket costs for vaccines beginning in 2023, chances are you were probably charged a copayment for vaccines billed to your Part D insurer instead of Part B.

In 2021, before the law changed, 3.4 million people received vaccines under Part D, paying $234 million in out-of-pocket costs. Broken down by vaccine, that averages to about:​

• $77 per patient for the shingles vaccine
• $28 for the Tdap vaccine
• $34 for the hepatitis A vaccine
• $51 for the hepatitis B vaccine

Before 2023, some people paid as much as $193 for the shingles vaccine and $66 for the Tdap vaccine, according to the Centers for Medicare & Medicaid Services.

In 2023, more than 42 percent more people received the shingles vaccine than in 2021, and 112 percent more people received the Tdap vaccine in 2023 than in 2021.

Keep in mind

Medicare Advantage plans must cover the same Part B preventive services without any cost to you if you use an in-network provider. You may be charged if you use an out-of-network provider.

If your Medicare Advantage plan includes drug coverage, it must also cover the Part D vaccines the CDC recommends (listed above) without cost sharing.

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