Medicare does cover many of the vaccines recommended for older adults, but it does not pay for all of them universally. Coverage depends on the type of vaccine and the specific Medicare plan you have. Generally, Medicare Part B covers certain vaccines that are considered preventive and medically necessary, while other vaccines may be covered under Medicare Part D or may require out-of-pocket payment.
For adults aged 50 and older, the Advisory Committee on Immunization Practices (ACIP) recommends vaccines such as influenza (flu), shingles (Shingrix), Tdap (tetanus, diphtheria, pertussis), pneumococcal vaccines, and the updated COVID-19 vaccine. Medicare Part B covers the full cost of the flu vaccine every year, the pneumococcal vaccines (including PPSV23 for all adults 65 and older and PCV13 based on shared clinical decision-making), and the COVID-19 vaccines approved by the FDA. It also covers the Shingrix vaccine, which is highly effective in preventing shingles and its complications, for adults 50 and older. Additionally, Medicare Part B covers the respiratory syncytial virus (RSV) vaccine for those who meet ACIP guidelines, which is important because RSV can cause serious respiratory illness in older adults.
However, vaccines like Tdap may not be covered under Medicare Part B unless administered in specific circumstances, such as after an injury that could lead to tetanus. Instead, these vaccines might be covered under Medicare Part D, which is the prescription drug plan. Coverage under Part D varies by plan, and beneficiaries may have to pay copayments or coinsurance. This means that while Medicare covers many recommended vaccines, some may require navigating different parts of Medicare or paying some costs out of pocket.
It is also important to note that vaccine coverage can sometimes be confusing due to changes in vaccine recommendations, FDA approvals, and Medicare billing systems. For example, some Medicare beneficiaries have experienced initial denials for COVID-19 vaccine coverage due to system updates, but these issues are typically resolved by contacting Medicare or the provider. To avoid surprises, it is advisable to check with your healthcare provider or pharmacy before getting vaccinated to confirm coverage and any potential costs.
Older adults should keep accurate records of their vaccinations and discuss with their healthcare providers which vaccines are recommended based on their age, health status, and vaccination history. Staying up to date on vaccines is crucial because the immune system weakens with age, increasing susceptibility to infection
