Smiling child

Take a Minute for Medicare

This is the last of a three part series on Medicare Preventive Services. This final article will focus on the most common preventive service that most Medicare beneficiaries receive, Part B covered vaccines.

Preventive vaccines (flu, pneumonia, and hepatitis B vaccines) are typically covered by Medicare at little or no cost to you. There are specific rules you must follow in order for Medicare to cover your vaccine as a preventive service: 

Flu shot – Part B will cover a flu shot once every flu season. This is true for both Original Medicare and for Medicare Advantage Plans. The flu season usually runs from November through April, which spans the fall of each year through the winter of the following year. For example, the 2015/2016 flu season started in fall 2015 and goes through winter 2016. Therefore, Medicare may cover a flu shot twice in one calendar year. For example, if you received a shot in January 2015 for the 2014/2015 flu season, Medicare would cover another shot in November 2015 for the 2015/2016 flu season. Currently, the seasonal flu shot typically includes both a seasonal flu shot and an H1N1 (swine flu) vaccination.

Pneumonia shot – Medicare will cover 100 percent of the cost of two separate doses of the pneumonia vaccine with no Part B deductible whether you have Original Medicare or a Medicare Advantage Plan. Medicare Advantage Plans cannot require that you get a referral for the vaccine, but can require that you use in-network providers to administer it. If you have Original Medicare, you will have no copay or deductible if you see providers who take assignment. Currently, there are two types of pneumonia vaccines available. Medicare Part B will cover an initial pneumonia vaccine if you have never before received the pneumonia vaccine under Medicare Part B. Medicare will also cover a second type of pneumonia vaccine at least one year after the first vaccine is administered. Speak with your doctor to learn more about the types of pneumonia vaccines and to discuss receiving them.

Hepatitis B shot – If your doctor considers you to be at low risk for hepatitis B, the shot will be covered under Medicare Part D. Part B will cover your hepatitis B shot if your doctor finds that you are at medium to high risk for hepatitis B and orders the vaccine. This is true for both Original Medicare and Medicare Advantage Plans. Your risk for Hepatitis B increases if you have hemophilia, End-Stage Renal Disease (ESRD), diabetes, or certain conditions that lower your resistance to infection.

It is very important to remember that the Shingles vaccination is not a Medicare Preventive service. Generally, the Shingles shot, and all other commercially available vaccines, is covered under Medicare Part D. Contact your Part D plan for more information about coverage.

Next month we will start a new three part series focusing on Extra Help for Medicare Part D.
For general Medicare questions, call DRW at 1-800-928-8778. For Medicare Part D questions, call the Disability Drug Benefit Helpline at 1-800-926-4862. You can also call 1-800-MEDICARE (1-800-633-4227), or visit www.medicare.gov to find out if Medicare covers your test, service, or item.