What vaccines are covered by Medicare? A need-to-know list

What vaccines are covered by Medicare? A need-to-know list

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It’s already August, and believe it or not, we are already talking about the flu shot and flu season. Can you believe it? It seems to come earlier and earlier each year. This brings up a topic that many people aren’t completely clear about: What important vaccines are covered by Medicare, and why are they so important to know about?

Covering preventive services is one of the most important parts of Medicare’s role in keeping people healthy. Whether reinforcing immunizations you received as a child, or preparing you for the upcoming flu season, vaccines are a key part of avoiding diseases that can prevent you from staying healthy.

Medicare helps pay for four vaccines, each of which you should discuss with your doctor to protect yourself. They are:

Influenza Vaccine

The flu (or influenza) is a contagious respiratory illness that can be severe and life-threatening. Why is this vaccine so important? Older adults, even healthy older adults, are at higher risk of the flu because of age-related weakening of our immune systems, making it more difficult for us to fight off disease. For adults 65-plus who are managing a chronic condition — such as diabetes, chronic obstructive pulmonary disease or heart disease — the flu can be even more dangerous because you are more likely to develop complications or become hospitalized. According to the Centers for Disease Control and Prevention, flu combined with pneumonia is one of the top 10 causes of death for those age 65 and older in the U.S., another reason they recommend the flu vaccine as the best way to prevent the flu. A higher dose vaccine was specifically created for older adults to address the increased risks faced by the aging population, so talk to your doctor soon (especially with flu season right around the corner) about this option.

How can Medicare beneficiaries take advantage of this flu shot benefit? The flu vaccine is a once-a-year, cost-free Medicare B benefit. This means, if you have original Medicare (not an advantage plan; you must know what you have, and you must know the difference), you must use a physician or health care provider who accepts Medicare assignment. Medicare Advantage patients may have to use an in-network doctor or pharmacy, so if you are an MA customer, it’s always best to call the number on the back of your card to see where you can get the shot for free.

Shingles Vaccine

Shingles is a painful skin rash that’s caused by the same virus responsible for chicken pox. Shingles is less contagious than chicken pox and can only be passed on to another person up until the point when the infected person’s blisters begin to scab. Even after shingles passes, long-term pain can linger.

Why should older adults get the shingles vaccine? Researchers believe the age-related weakening of our immune systems can trigger the “reawakening” of the dormant chicken pox virus. The CDC says one in three adults contracts shingles at some point in their life, the majority of whom are 60 years or older, and 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 additional infections. Whether you remember having chicken pox as a child or not, you should still talk to your doctor about getting vaccinated.

How does Medicare cover the cost of the shingles vaccine? All Medicare Part D drug plans, or Medicare Advantage plans that include prescription coverage, typically cover the shingles vaccine. However, there is usually an out-of-pocket cost. Depending on your plan, you will either be responsible for a co-payment (fixed dollar amount) or co-insurance (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 always 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.

Pneumococcal Vaccine

What is pneumococcal disease? Pneumococcal disease causes severe infections throughout the bloodstream and/or key organs. While you may not have heard of pneumococcal disease, you have probably heard of the conditions that result from this disease, including pneumonia, meningitis and bacteremia (infection of the bloodstream). Pneumococcal disease can result in deafness, brain damage, loss of limbs and even death.

According to the CDC, this vaccine is important to consider because pneumococcal disease kills 18,000 adults age 65-plus each year. A weakening immune system means that older adults are at greater risk and can face more severe side effects, especially those who are managing chronic diseases.

How does Medicare cover the cost of the pneumococcal vaccine? The pneumococcal vaccine is a cost-free benefit covered by Medicare Part B. For original Medicare, you must use a physician or health care provider who accepts Medicare assignment, and for Medicare Advantage, you may have to use an in-network doctor or pharmacy. Again, always call your insurance provider to make sure you are getting the shot in the right place, or it could lead to out of pocket costs you weren’t expecting.

Hepatitis B Vaccine

What is the hepatitis B virus? Hepatitis B (or hep B) is a contagious virus that infects the liver. Acute hep B, which usually lasts a few weeks, often mimics symptoms similar to the flu, such as fever and nausea. Chronic hep B is long-term, often has no symptoms at all, and can cause liver damage or death.

The CDC says this vaccine is important for older adults to get because as we age, the liver and its function change, making hep B more prevalent among older adults. In fact, your risk of contracting hepatitis B increases if you have hemophilia, end-stage renal disease, diabetes or other conditions that lower resistance to infection. Acute hep B is particularly dangerous for older adults because there is no specific treatment for the symptoms.

How does Medicare cover the cost of the hepatitis B vaccine? Medicare Part B insurance covers the full cost of the hep B vaccine(s) if a doctor determines that you are at high or medium risk of contracting the hep B virus and the physician or health care provider administering the vaccine accepts Medicare assignment. Consult your doctor to determine your risk of getting hep B.

In conclusion, make the most of your Medicare coverage. Getting these vaccines is an important part of staying healthy as you age. They also help ensure the health of your friends and family. Call your doctor today to see if these vaccines are right for you, and then check with your Medicare provider about where you can get them and what is your expected out of pocket cost. If you know someone who may not be vaccinated, share this information with them so they can take the next step toward protecting themselves.

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