For you, a vaccination is a vaccination; it protects you against something. But, under Medicare, all vaccines are not equal and that means you probably paid more for some than for others.
The coverage for a vaccine depends on the part of Medicare under which it falls.
Part B, medical insurance, covers most vaccines that Medicare beneficiaries need. There is no copayment for those that every Medicare beneficiary should get, specifically:
- COVID vaccinations (no matter how many shots you get)
- Prevnar 13® and Pneumovax® 23 (pneumonia vaccines), and
- The flu vaccine.
Those who chose Original Medicare can get the vaccine from any doctor or pharmacy that accepts Medicare assignment. Medicare Advantage plans members should visit a doctor or pharmacy in the plan’s network. No matter the type of Medicare you have, there is no deductible, copayment or coinsurance.
Public service announcement about the flu
During the 2020-2021 flu season, flu was practically nonexistent. That’s because of all the handwashing, masking, sheltering at home and social distancing we did to control the spread of COVID. The impact of all these practices carried over into the next year with another mild flu season. But that may change this year.
Experts are predicting that the 2022-2023 season could be severe. People are traveling again, getting out in public, and may not be paying attention to the same good old infection-control practices. (At a recent conference, I saw one woman leave the restroom without washing her hands, something I have not seen since before the pandemic.) With all the attention on COVID, we can’t overlook the flu. Don’t take chances. If you haven’t already done so, get your flu shot now.
Part D, prescription drug coverage, covers the vaccines that Part B doesn’t. Probably the two most important for seniors would be the Shingrix and DTaP (diphtheria, tetanus, and pertussis) vaccinations. Even though these are just as important as Part B vaccines, Part D vaccines have been treated differently when it comes to cost. They are subject to the drug plan deductible and carry hefty copayments. In my ZIP code, the copayment for DTaP is around $70 and for Shingrix, almost $200 an injection. (Shingrix is administered as a 2-dose series with the second one given anytime between two and six months after the first.) If someone had to get all the vaccinations in 2022, that would be about $470. Given these are generally subject to the deductible ($480 in 2022), it’s likely the entire amount would come out of one’s pocket.
That will change as of January 1, 2023. Just as with the flu, COVID and pneumonia vaccinations, Part D vaccines will not be subject to a deductible and there will be no copayment. Keep these points in mind.
- Even though there will be no cost for these vaccines next year, do not delay if you are at risk or already received the first Shingrix shot.
- The best way to get these vaccinations is to visit a pharmacy that’s in your Part D drug plan’s network.
- Even though the Medicare Plan Finder has been updated for 2023, the plan information still shows the copayments. That will likely change as of January 1 when the new rule takes effect.
Now that there will be no cost for important vaccinations and you can get them at a pharmacy, there are no good excuses for not getting vaccinated.
PS: Fear of needles is not a valid excuse. Make an appointment today.