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Medicare

Which Vaccines Does Medicare Cover?

Geoff WilliamsJoshua Murdock, PharmD, BCBBS
Written by Geoff Williams | Reviewed by Joshua Murdock, PharmD, BCBBS
Updated on November 8, 2024
Doctor cleaning a male patient's arm with a cotton swab before giving him a shot while he sits in a wheel chair.
PixelsEffect/E+ via Getty Images

Key takeaways:

  • Most vaccines are covered for Medicare enrollees who have Part D coverage.

  • A few vaccines — including COVID-19, flu, and pneumococcal vaccines — are covered under Medicare Part B.

  • If you have Medicare, your vaccines should be covered without any cost-sharing. That means you pay nothing and are not responsible for deductibles or copays.

Access savings on related medications

If you’re covered by original Medicare or a Medicare Advantage plan and have Part D prescription coverage, you can get most vaccines without any cost-sharing. In other words, most vaccines are covered by your Medicare plan without any out-of-pocket costs.

Let’s talk more about how this happened, as well as coverage specifics.

Which vaccines are covered by Medicare?

Most vaccines are covered by Medicare. What may be tricky is understanding what part of Medicare covers a particular vaccine. Depending on the vaccine, you may be covered by Part B outpatient insurance or Part D prescription coverage. There is no cost-sharing with covered vaccines, even if you get the vaccine from a healthcare professional who is outside of your plan’s network. You also don’t have to pay for vaccine administration. (If you are charged a vaccine administration fee by an out-of-network vaccine provider, you can get reimbursed by your Part D plan.) 

Medicare Part B coverage

This is the part of original Medicare that covers outpatient services, as well as some medications and vaccinations. Some vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) and covered by Medicare fall under Part B. The most common vaccines that Part B covers include:

It’s important to note that Part B also covers vaccines that treat an injury or exposure to disease. For instance, Part B should cover your tetanus shot if you step on a rusty nail and your healthcare professional recommends this vaccine. The same goes for a preventive rabies shot following a dog bite. But, if you get a tetanus booster shot not related to injury or illness, that’s covered by Part D.

Medicare Part D coverage

This part of Medicare covers most prescriptions and vaccinations. If you have original Medicare (Part A and/or Part B), you will need to buy a standalone Part D prescription plan. Most Medicare Advantage plans include Part D coverage. If Part D isn’t included in your Medicare Advantage plan, you can buy a standalone Part D plan for prescription coverage.

The vaccines covered under Part D include:

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  • Without insurance, get a flu shot for less than $100. Self-pay flu shots typically cost $25 to $90, and you may be charged a little more for the administration fee.

  • Shingrix shots cost hundreds of dollars if they’re not covered. Without insurance, expect to pay about $200 per dose for a shingles shot and $400 total for the two-dose regimen.

  • You may qualify for free or low-cost vaccines. Typically, vaccines at health departments and community health centers cost less and may be free.

No out-of-pocket costs for people with Medicare, Medicaid, and commercial insurance

Most adults who have insurance pay nothing for most vaccines. That’s because the Affordable Care Act (ACA, also known as Obamacare) and the Inflation Reduction Act of 2022 don’t allow you to be charged out-of-pocket costs for certain vaccines if you’re covered by:

  • Medicare Part B

  • Medicare Part D prescription plans (which cover most vaccines for Medicare enrollees)

  • Most commercial insurance plans

  • Medicaid

With health insurance, you will not have cost-sharing for vaccines recommended by ACIP. Those vaccines protect you against:

Some vaccine categories above, such as shingles, have just one FDA-approved vaccine (Shingrix) available in the U.S., while COVID and influenza (flu) each have multiple vaccines available.

Which vaccines are NOT covered by Medicare?

While most vaccines are covered with no cost-sharing for Medicare enrollees with Part B and Part D coverage, there are times you could find yourself paying out-of-pocket costs. These scenarios include:

Frequently asked questions

Often, you can find vaccines for free or at a low cost at government-funded health departments and community health centers. If you have insurance, you may qualify for copay assistance through manufacturer copay cards or other savings programs. If you don’t have insurance or are underinsured, you may qualify for free vaccines through patient assistance programs.

The bottom line

If you have Medicare Part B and Part D, you can get almost any vaccine that you need with no cost-sharing. That means most vaccines and administration fees are covered without you paying anything. Not all Medicare enrollees have Part D prescription plans, which cover most vaccines. A few vaccines — COVID-19, flu, hepatitis B, and pneumococcal — are covered under Medicare Part B, which may be provided by original Medicare or a Medicare Advantage plan. Your Part D coverage may be a standalone plan with original Medicare or with a Medicare Advantage plan that lacks prescription coverage, though most Medicare Advantage plans include Part D.

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Why trust our experts?

Geoff Williams
Written by:
Geoff Williams
Geoff Williams has been a journalist since 1992, when he got his start in entertainment journalism and then branched out into business writing and personal finance. Over the years, he has written forLife magazine, Ladies' Home Journal, CNN Money, Reuters, Consumer Reports, the Washington Post, Entrepreneur magazine, and Forbes, among others.
Cindy George is the senior personal finance editor at GoodRx. She is an endlessly curious health journalist and digital storyteller.
Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

References

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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