Medicare does cover vaccine-related medical treatment, but the coverage depends on the type of vaccine and the part of Medicare you have. Medicare is divided mainly into Part A, Part B, and Part D, and each part covers vaccines and related treatments differently.
Medicare Part B covers vaccines that are typically given in outpatient settings and are considered preventive or medically necessary. These include the flu shot, pneumococcal vaccines (which protect against pneumonia and other infections), hepatitis B vaccine for those at medium or high risk, and COVID-19 vaccines including all recommended doses and boosters. Part B also covers certain exposure-related vaccines like tetanus and rabies when medically necessary due to injury or exposure. Importantly, these vaccines under Part B are covered in full, meaning there is no deductible or copayment required when you receive them at a doctor’s office, clinic, or pharmacy that accepts Medicare.
If you receive an injection or vaccine as part of a hospital stay, Medicare Part A covers that treatment as part of your inpatient care. This means if you are hospitalized and receive a vaccine during that stay, it is covered under Part A.
For vaccines not covered under Part B, Medicare Part D—the prescription drug coverage part—steps in. Part D plans cover vaccines such as the shingles vaccine (Shingrix), MMR (measles, mumps, rubella), DPT (diphtheria, pertussis, tetanus), RSV (respiratory syncytial virus), and hepatitis A vaccine when recommended based on risk factors. Coverage under Part D depends on your specific prescription drug plan, which may place vaccines into different tiers affecting cost-sharing. However, vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are generally covered with no out-of-pocket cost under Part D plans.
The shingles vaccine is a good example of Part D coverage. Shingrix is highly effective at preventing shingles and its complications, and Medicare Part D covers it fully with no copayments or deductibles as long as you have a Part D plan. Similarly, the RSV vaccine, which protects against a common respiratory virus that can be serious for older adults, is covered under Part D if you meet eligibility criteria.
It’s important to note that while Medicare covers these vaccines, the setting where you get vaccinated matters. Vaccines covered under Part B are usually administered in outpatient settings like doctors’ offices or pharmacies, while Part D vaccines may require you to us
