Medicare’s updated vaccine and immunization list

Medicare vaccine coverage 2023 includes major updates every participant should know about before choosing a plan. This improved immunization process offers no-cost vaccines for the most vulnerable of Kansans, and it is a welcome relief to those struggling to pay the high costs of healthcare. 

There is a lot of outdated misinformation on the internet about the 2023 Medicare changes, vaccines specifically. The Blue Cross Blue Shield Kansas team put together this information to make sure you have accurate, updated, and clear information about what vaccines are covered by Medicare. 

You should not assume last year’s plan covers the same vaccinations as last year, and you should not miss a chance to explore cost savings in other plans with expanded vaccine coverage. 

Overview of Medicare and vaccines

Medicare goes by the list of recommended vaccines from the Advisory Committee on Immunization Practices (ACIP), which is backed up by the Centers for Disease Control and Prevention (CDC)

It’s important to note a few elements that could impact your eligibility for a vaccine:

  • Recommended Vaccines for General Population 65+: There are certain vaccines that are recommended annually or at another interval for those on Medicare. 
  • Immunization History: Some additional vaccines are covered for those who have an incomplete or unknown vaccination history. For example, you might have missed an important vaccination earlier in life that you need now.
  • Pre-Existing Conditions: There are some health issues that bring additional vaccine recommendations that an otherwise healthy person might not receive. 

Patients will also need doctors to prescribe certain immunizations. You should confirm with your primary care provider before getting any vaccine. The Blue Cross Blue Shield Kansas Team is happy to address any questions you have about Medicare vaccines 2023 offers.

Does Medicare cover COVID-19 vaccines?

The COVID-19 vaccine is considered preventative care and is covered by Medicare as long as the vaccine brand is FDA-authorized or FDA-approved. You pay no out-of-pocket costs. 

Coverage includes:

  • Initial COVID-19 Vaccine
  • COVID-19 Booster Shots
  • COVID-19 Additional Doses (as prescribed by your doctor)
  • Testing for COVID-19: Full coverage if your test is done in a lab or hospital at the request of your doctor Medicare Part B covers 8 over-the-counter tests during the COVID-19 public health emergency
  • COVID-19 Antibody Testing
  • Monoclonal Antibody Treatments: This must be during a year when a public health emergency is declared, and your doctor must order the treatment

New in 2023: free shingles vaccine for seniors

All Medicare patients need to be aware that the shingle vaccine is now covered with no out-of-pocket costs for those with Part D prescription coverage. This is a big change from your previous plan, so discuss this with your Blue Cross Blue Shield Kansas representative to ensure you get the right plan for your needs. 

FACT: Around 36,000 Kansas Medicare beneficiaries received vaccine coverage through Part D in 2020. Those numbers are likely to increase with the no out-of-pocket costs for vaccines as part of the new 2023 plan approved by the Inflation Reduction Act

Does Medicare cover the flu shot?

The influenza vaccine, commonly referred to as the flu shot, is covered by Medicare. Confirm that the doctor or medical office giving you the shot accepts the Medicare assignment for no out-of-pocket costs. 

Does Medicare cover the Tdap shot?

The Tdap vaccine offers protection against tetanus, diphtheria, and whooping cough (pertussis). This shot is needed once every 10 years as an adult, and you can get a Tdap vaccine if you’ve never had one before. Then you’ll get one every 10 years after that. 

Tdap shots are only covered under Medicare Part D. New in 2023, you’ll pay no out-of-pocket cost for a Tdap vaccine if your doctor recommends it. 

Does Medicare cover the Pneumonia vaccine? 

Known as the pneumococcal shots, this helps prevent infections, including several varieties of pneumonia. Your doctor can recommend one dose or a two-dose schedule which will be covered at no out-of-pocket costs to patients. 

Pneumococcal vaccines also prevent certain types of meningitis but speak with your healthcare provider about whether you need the additional meningococcal vaccine, which isn’t on the list of recommended vaccines by the ACIP. This question is especially important to discuss if you are traveling internationally. We’ll discuss international travel more in-depth later in this article. 

TRAVEL GUIDANCE: Search the list of recommended vaccines based on your destination through the CDC website “Destination List.”

Does Medicare cover hepatitis A & B shots? 

The Hepatitis B vaccine is recommended for adults between 19 -59 years of age, which is before Medicare coverage would begin unless you are on a Special Needs Plan (SNP). The only coverage of Hep B shots under Medicare is if you have a high-risk factor, such as:

  • Diabetes
  • End-Stage Renal Disease
  • Hemophilia
  • Living with someone who has Hep B
  • Working in a healthcare setting

Your doctor will determine your risk factor, and if you need a Hep B shot, it will be covered at no cost to you. 

Hep A vaccines would be covered under Medicare Part D, but since it’s not on the recommendation list of ACIP, you’ll likely be paying out of pocket. Talk to your BCBS Kansas representative for details. 

Does Medicare cover HPV vaccines?

Human Papillomavirus (HPV) isn’t recommended for adults once they reach middle age. At that point in life, most people have been exposed to the virus in some form, so it’s unlikely to be beneficial the older a patient gets. However, Medicare does cover HPV testing every five years, but only to the age of 65. 

Those over 65 will get coverage for breast and pelvic exams once a year or once every other year, depending on their risk factors. 

Does Medicare cover vaccines for traveling abroad?

Traveling to another country can bring another consideration of required or recommended vaccines. It’s important you review the CDC list of recommendations for each county. If a vaccine isn’t part of the recommendations by the ACIP, you’ll likely be responsible for 20% of the costs and a deductible. It’s important to review your plan’s formulary for 2023 since vaccine coverage changed due to the Inflation Reduction Act. 

When reviewing the list of required vaccines, take note of the following items:

  • Your immunization history can impact whether you need a certain vaccine
  • Some vaccines are recommended for only children or young adults
  • Note which vaccines are required vs. recommended for your travel destination
  • Some vaccine requirements are based on a timeline, so you don’t want to get a vaccine too early or too late

SAFETY TIP: It’s important you know the travel risk of where you are going. The U.S. State Department lists travel concerns and warnings for all international destinations. While this isn’t vaccine-related, it’s still important to your safety as a traveler. 

For those taking a cruise, domestically or internationally, you should also review the list of required vaccines, including COVID protocol. 

Vaccines Medicare Does Not Cover

A hallmark of Medicare coverage things on “Medically Necessity,” meaning any cosmetic or non-necessary injection would not be covered. This would include items like Botox to treat wrinkles, as that’s a cosmetic choice. 

Another example is the popular Vitamin B12 shots, said to increase energy and help with weight loss. Medicare doesn’t cover B12 categorically, but if it’s deemed medically necessary by a doctor, the injections could get covered under Part B or Part D.

Medicare also won’t cover a vaccine that is beyond the list of recommendations that you simply want to get. Your doctor will need to prescribe any vaccination in order for Part B or Part D to offer even partial coverage. 

Does Medicare mandate vaccines?

There are no vaccines that a patient will be forced or pressured to get. Even refusing the highly recommended vaccines won’t impact any Medicare health plan, but not getting the vaccines could lead to more health issues and higher costs for patients. As always, speak with your doctor about concerns you have with any vaccination.

Part B vs. Part D vaccine coverage: let us help

Since both Medicare Part B and Part D cover certain vaccines, it can be confusing when you’re selecting a plan. In general, Medicare Part B is going to cover any vaccine that is preventative – like the flu, pneumonia, hep b, and COVID-19 vaccines. 

Part D is going to cover anything that is not preventative but still on the recommendation list for your specific health needs and immunization history. It’s important you bring up vaccination questions to your provider during your annual Wellness Visit or your Welcome To Medicare Preventative Visit.

There are too many changes in 2023 to assume your old plan still offers the best coverage. We can help. The Blue Cross Blue Shield Kansas team is well-versed in the available plans and the Kansas-specific requirements all participants should review before selecting a plan. 

Our plan advisors are ready for your call at 866-627-6705. You can also schedule a consultation or take part in a virtual seminar.

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