And as you get older, your immune system tends to provide less protection for you against serious illnesses. Most seniors also suffer from various chronic illnesses such as heart or lung diseases or other comorbidities that increase the risk of infection.
Medicare recognizes that one of the most effective ways to reduce risk is to practice comprehensive preventative care.
Medicare Part B covers many of these preventative services, including screenings, counseling, and vaccines. Medicare Part C (Medicare Advantage) and Medicare Part D (Prescription Drug Plans) also offer these services. If you meet eligibility and guidelines and requirements for a preventative service, you must receive the benefit under Medicare. Note, the various plans have different types of coverage rules, so be sure to check with your provider when needed.
Under Original Medicare (Part A and Part B), you pay no coinsurance or deductibles for most preventative services when you see a participating provider.
The U.S. Preventive Services Task Force recommends preventive services covered at 100% of the Medicare-approved amount. However, for other services, you may be charged with Original Medicare cost-sharing.
If you're accessing preventative services under a Medicare Advantage plan, you pay nothing for services covered with zero cost-sharing by Original Medicare when you use an in-network provider. Plan providers must cover your care without charging deductibles, copayments, or coinsurance if you meet Medicare's eligibility requirements for the service. But you could be charged for services that Original Medicare does not cover with zero cost-sharing.
You might also have out-of-pocket expenses if you see an out-of-network provider or receive services related to your preventative service, even if the preventive service itself is covered at 100% of the cost.
Each preventative service has unique eligibility requirements and guidelines. For this reason, Medicare may only cover a service a limited number of times each year or under certain specific circumstances.
There are several types of vaccines that are covered by Medicare and recommended for seniors. They include:
COVID-19 vaccine. COVID-19 remains an active and serious worldwide threat. Seniors are at the highest risk of dying from COVID-19, thus making vaccinations a primary priority. Some may opt out of getting the Covid vaccine for personal reasons. Others may opt out if they had a severe allergic reaction after taking the first dose. However, in general, the vaccine remains a safe and effective course of care for most Medicare recipients.
Influenza (Flu) vaccine. Seniors should get the flu vaccine every year. Many do not realize there is an extra-strong vaccine explicitly made for seniors that generate more antibodies to fight the flu virus better.
Do not overlook this vaccine. In most seasons, about 90 % percent of all hospitalizations from the flu occur in people over 65.
Medicare Part A does not cover flu shots. Medicare Part B covers one flu shot per flu season which usually runs from November through April. You pay nothing for a flu shot if your doctor or other qualified health care provider accepts the assignment for giving the shot.
Medicare does not cover nasal spray flu vaccines because the FDA has not approved them for seniors.
If you have a Medicare Advantage plan, contact your provider to verify coverage. Private plans may not require you to get a referral to receive the flu shot, but they may require that you receive the shot within your plan's network.
If you go out of network, you could wind up paying $150 or more, so it is a good idea to do a little homework before you get this vaccine.
Also, Medicare covers additional flu shots if deemed medically necessary.
Shingles vaccine. Shingles is caused by the chickenpox virus that reactivates in your nerves and leads to a painful rash. According to the Centers for Disease Control, about 1 in 3 people in the U.S. will develop shingles during their lifetime, and nearly half of all cases occur in men and women over 60.
Although it is not usually deadly, it can be painful and long-lasting. A new vaccine that protects against Shingles, called Shingrix, was approved for adults over age 50 in 2017. It is 90% effective and recommended over the old vaccine, Zostavax, which was discontinued in 2020.
Pneumonia vaccines. There are two approved vaccines to prevent complications related to pneumonia. Pneumovax (PPSV23) is recommended once for all adults over 65. Prevnar 123 (PVC13) is recommended for older adults with certain risk factors such as a suppressed immune system.
Tetanus/whooping cough vaccine (Tdap). The tetanus vaccine is given as a combination vaccination with diphtheria, which can cause a serious nose and throat infection and whooping cough (pertussis). The recommendations are the same for younger and older adults, which is to get a booster every 10 years. In some cases, older adults get the Tdap vaccine if they are going to be grandparents for the first time to protect a newborn baby from catching whooping cough.
Hepatitis B vaccine. Most people were vaccinated against the hepatitis B virus as children. If you are at a higher risk of getting hepatitis B, it is a good idea to discuss the possibility of getting this vaccine with your healthcare provider.
Medicare Part D prescription drug plans usually cover various vaccines when they are considered reasonable and medically necessary. An insurance company Part D plan may also cover vaccines you could need if you are traveling internationally.
Common vaccines under Part D coverage include:
Information is for educational purposes only and should not be construed as an offer of insurance, advice, or recommendation. The information provided is not intended as tax, financial, investment or legal advice. Please consult legal or tax professionals for specific information regarding your individual situation.
Not connected or endorsed by the US Govt or the Federal Medicare Program. Medi-Solutions Insurance Agency, LLC is an independent Life, Accident and Health Insurance Agency, NJ Ref#1642311. Some plans and features may not be available in all states.
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