Medicare Coverage for Vaccines

The Medical Center administers most vaccines including Influenza vaccines, Pneumonia vaccines, Comirnaty (COVID vaccine), Tdap (tetanus, diphtheria, pertussis vaccine), Td (tetanus, diphtheria vaccine), Hepatitis A, B, and A+B, Shingrix (shingles vaccine), and Arexvy (RSV vaccine).

The Inflation Reduction Act of 2022 brought some good news for people with Medicare. Vaccines under Medicare prescription drug plans (Part D) are covered without co-pays since 2023.

For those with Medicare, some vaccines are covered under Medicare part B and others are covered under Medicare Part D. Medicare B covers COVID, Influenza, Pneumonia, and Hepatitis B vaccines. Medicare Part D covers Tdap, Shingles, RSV, and Hepatitis A vaccines at retail pharmacies.

Commercial insurances cover vaccines, as well as most of the Medicare Advantage Plans (Part C) offered by private companies that contract with Medicare. These plans are inclusive of Parts A & B and usually Part D.
Medicare D previously did not cover some vaccines when given at a doctor’s office unless the office utilized web -based portals for submission.

The Medical Center has acquired new software, TransactRx, in order to verify eligibility and assist in billing Medicare part D for vaccines. Now, patients can receive their vaccines here at the Medical Center instead of leaving Ocean Reef to go to a local pharmacy. For those who want to get their vaccines at retail pharmacies, you may still do so.