Vaccine Coverage

Most preventive vaccines are covered under Medicare Part D Prescription Drug Coverage while a few are covered under the Part B Medical Coverage. It’s important to know what vaccines are covered, your potential out-of-pocket costs, and where to get it.

Part D Covered Vaccines

Medicare Part D covers vaccines not covered by Part B (medical) as long as the vaccine is reasonable and necessary to prevent illness.

• A few examples of Part D covered vaccines include Zostavax (Shingles) vaccine, Tetanus vaccine, and MMR (measles, mumps, rubella) vaccine.

Where should I get my preventive Part D vaccines?

What you pay for vaccinations covered by Part D depends on how and where you get them.

1. You get a prescription from your physician, take it to a network pharmacy and get your Part D vaccine at the network pharmacy. You will have to pay the pharmacy the amount of your copayment (if applicable) and the cost of giving you the vaccine. Our plan will pay the remainder of the costs.

2. You get a prescription from your physician, take it to a network pharmacy and have it filled as a prescription and then take it to your physician’s office where they administer the Part D vaccine. You will have to pay the pharmacy the amount of your copayment (if applicable) for the vaccine itself. You will pay the entire cost of the service for the physician to give you the vaccine. You can then ask our plan to pay our share of the cost by submitting a reimbursement request. You will be reimbursed the amount charged by the doctor for administering the vaccine less any difference between the amount of the doctors’ charges and Medicare’s allowable charge.

3. You get the Part D vaccinations at your physician’s office. Your initial out-of-pocket costs may be higher if you obtain these vaccines at a physician’s office. When you get the vaccine, you will pay for the entire cost of the vaccine and its administration. You can then ask our plan to pay our share of the cost by submitting a reimbursement request. You will be reimbursed the amount you paid less your normal copayments for the vaccine (if applicable) including administration, and less any difference between the amounts the doctor charges and Medicare’s allowable charge. Please check with your physician to see if they are contracted with TransactRx Vaccine Manager. TransactRx Vaccine Manager allows your physician to bill for Part D vaccines and have them processed under your Part D coverage, therefore, potentially saving you money and time by not having to take your prescription to the pharmacy. For information on Part D vaccine tiers, access our current drug formulary. Locate a network pharmacy by using our Find Your Pharmacy tool.

Part B Covered Vaccines (Covered under your Medical benefit)

Medicare Part B covers the following vaccines:

• Influenza (flu) virus vaccine;
• COVID-19 vaccine;
• Pneumococcal (pneumonia) vaccine;
• Hepatitis B vaccine (if you are at medium to high risk per your physician); and
• Vaccines directly related to the treatment of an injury or direct exposure to a disease or condition.

Where should I get my Part B vaccines?

You can obtain these vaccines through your network physician. You can also get your flu shot at one of our network pharmacies.