Which Vaccines Does Medicare Cover?
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.
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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.)
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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:
COVID-19
Flu
Hepatitis B (for individuals at high and intermediate risk)
Pneumonia (pneumococcal)
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:
Anthrax
DTaP-IPV-Hib-HepB, a combination of diphtheria, tetanus, pertussis (whooping cough), inactivated polio virus, Haemophilus influenzae, and hepatitis B
DTaP/Tdap/Td, a combination of diphtheria, tetanus, and pertussis
Varicella (chickenpox)
Zoster (shingles)
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
With health insurance, you will not have cost-sharing for vaccines recommended by ACIP. Those vaccines protect you against:
Orthopoxviruses (smallpox and Mpox)
Pneumonia (pneumococcal)
Varicella (chickenpox)
Zoster (shingles)
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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:
If you need a vaccine while traveling abroad, you might have to pay for those shots yourself. Medicare typically doesn’t cover health costs for enrollees who are traveling outside the U.S., though there are exceptions. If you have original Medicare, some Medigap plans offer limited benefits when you’re traveling abroad.
If you have Medicare without a Part D plan, you will be responsible for paying for vaccines covered under Part D.
Vaccines no longer authorized for use or available in the U.S., such as the Johnson & Johnson (J&J) COVID vaccine.
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.
Yes. For vaccines that you receive from a pharmacy (not a physician’s office), you may be able to save with a free GoodRx coupon.
Now that vaccines covered by Medicare Part B and Part D are available without cost-sharing, policymakers have turned their attention to negotiating prices for certain medications. Thanks to the Inflation Reduction Act of 2022, Medicare officials are negotiating prices directly with medication manufacturers. Costs for the first round of 10 medications — which treat conditions including diabetes, heart failure, and psoriasis — were announced in August 2024, and lower prices are expected to be effective on January 1, 2026.
In addition, people with Medicare Part D will have an annual $2,000 out-of-pocket limit for prescriptions starting in 2025 because the coverage gap known as the donut hole will be eliminated. Also in 2025, insurers must offer payment plans for prescription out-of-pocket costs, with capped monthly amounts. This means that, instead of paying your entire part up front, you can make monthly payments for your share of prescription costs. This applies to standalone Part D plans and those included in Medicare Advantage plans.
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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References
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Anthrax vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Cholera vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Combined DTaP/IPV/Hib/HepB vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: COVID-19 vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Dengue vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Diphtheria, tetanus and pertussis (DTaP/Tdap/Td) vaccines.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Ebola vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Haemophilus influenzae type B (Hib) vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Hepatitis A vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Hepatitis B vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Human papillomavirus (HPV) vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Influenza (flu) vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Japanese encephalitis vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Measles, mumps and rubella (MMR) vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Measles, mumps, rubella, and varicella (MMRV) vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Meningococcal vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Orthopoxviruses (smallpox and Mpox) vaccines.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Pneumococcal vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Polio vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Rabies vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Respiratory syncytial virus (RSV) vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Rotavirus vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Tick-borne encephalitis (TBE) vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Typhoid vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Varicella (chickenpox) vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Yellow fever vaccine.
Centers for Disease Control and Prevention. (2024). ACIP recommendations: Zoster (shingles) vaccine.
Centers for Disease Control and Prevention. (2024). Vaccine-specific recommendations.
Centers for Medicare & Medicaid Services. (2024). Medicare drug price negotiation.
Medicare.gov. (n.d.). Costs in the coverage gap.
Medicare.gov. (n.d.). Tdap shots.
Medicare.gov. (n.d.). Travel outside the U.S.
Medicare.gov. (2024). Medicare covers most vaccines for free!
Medicare Interactive. (n.d.). Vaccines and immunizations.
Weiland, N., et al. (2024). U.S. unveils price limits for 10 costly or common medications. The New York Times.
