Which Vaccines Are All Medicare Part B Enrollees Covered For?

Vaccinations and flu shots are indeed an essential part of our health and wellbeing. Moreover, it is an effective way of taking preventative measures. These shots can play a vital role in preventing you from catching illnesses that can negatively affect your health. 

Generally, the Medicare beneficiaries depend on a Medicare-prescribed drug plan for all their vaccine coverage. But when it comes to Medicare part B enrollees, they are only provided coverage for specific vaccines. 

In this guide, we view the different vaccines for which all Medicare part B enrollees are covered, which vaccinations the Medicare Part B plan does not provide insurance for, and where an individual can utilize the vaccine coverage. 

List of Vaccines for Medicare Part B Enrollees

man getting vaccines

Typically, all Medicare Part B enrollees will be covered for specific immunizations, as follows: 

  • A seasonal flu shot.
  • A seasonal H1N1 vaccine for swine flu.
  • A pneumococcal vaccine for pneumonia. 
  • A different kind of pneumococcal vaccine if it is given at least one year after the former shot.
  • Shots for Hepatitis-B, for beneficiaries at high-risk. 

Sometimes, Medicare Part B also covers particular shots for employees if they are directly related to a physician’s treatment for an illness or an injury. For example, they can also be covered for a rabies shot if their physician has administered it after a dog bite. Beneficiaries can also be covered for tetanus shots, provided the Medicare Part B employees have accidentally stepped on a rusty nail. 

What Vaccines Are Not Covered By Medicare Part B?

The most general vaccines which are not covered by Medicare Part B are as follows:

  • Diphtheria, pertussis (tdap), and tetanus shots.
  • Shingles (herpes zoster) shots.
  • Meningococcal vaccines. 

How Does The Medicare Vaccine Coverage Work?

Medicare is a federal health and medical insurance program in the United States of America that primarily caters to the needs of the elderly. It comes in 4 parts, namely: 

  • Medicare Part A – It covers all the inpatient medical expenses.
  • Medicare Part B – It covers all the outpatient medical costs.
  • Medicare Part C – It is a private substitute to the Original Medicare (comprising both Part A and Part B), which also goes by the name of Medicare Advantage.
  • Medicare Part D – It is a prescription medicine coverage for all the beneficiaries of Original Medicare.

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How To Get Immunization That Is Not Covered By Medicare Part B?

Suppose you are a beneficiary who wishes to get an immunization that is not included in the Medicare Part B plan. In that case, you can easily rely on Medicare Part D or a Part C plan that is equipped with prescription drug coverage. These two plans are referred to as the Medicare Advantage Prescription Drug Plans (MAPD). 

As per the Centers for Medicaid and Medicare Services, all prescription drug plans should include all commercially accessible vaccines when they are medically required to prevent illnesses. However, some rules for the payment and administration of vaccinations vary from one plan to another, as do the coinsurance, copay, deductibles, and premiums. 

The vaccines that the Medicare Prescription Drug Plans usually cover and can be used by Part B beneficiaries include:

  • Tdap vaccine.
  • Shingles (herpes zoster) shot.
  • Bacille Calmette-Guerin (BCG) injection for tuberculosis (TB).
  • Mumps, measles, and Rubella (MMR) vaccines.
  • Hepatitis A and B vaccines for beneficiaries at low-risk.
  • Meningococcal vaccines.
  • A few self-governed insulin shots. 

Beneficiaries will need to contact their respective providers of this Medicare prescription drug plan to see which vaccines are being covered, where they can get them from, and how much they will need to pay for these vaccinations. 

You can even consult your prescription plan’s drug list or formulary to see if a particular vaccine is covered. However, you must note that formularies are not always updated. Your plan might include a new shot that may not have yet been included. Also, Medicare does not include any traveling-related vaccines. 

Who Is Covered For Medicare Part B Coverage?

Medicare Part B covers almost all adults at age 65 and above, either via a Medicare Advantage Plan or directly. 

Where Can I Use the Medicare Part B Medical Insurance Coverage?

  • Some notable pharmacies.
  • Medical offices.
  • A handful of local public health and medicine departments.