With two weeks left of the 2021 Medicare Annual Enrollment Period and talks of a COVID-19 vaccination in the works, you may be questioning what vaccines are covered by Medicare. The answer may surprise you!
While some vaccinations are covered by Medicare Part B, others are only covered in Medicare Part D, also called a prescription drug plan or PDP. A select few vaccinations may not be covered by Medicare at all!
When we think of vaccinations, we typically think of kids. Children get several rounds of shots leading up to adulthood, but vaccines are just as important for adults, too. This is especially true as we age. Some illnesses, like pneumonia and the flu, may cause serious issues for older individuals, so it is important to make sure clients are keeping up with their vaccinations to avoid getting sick.
Part B covers vaccinations that the Centers for Medicare and Medicaid Services (CMS) has deemed necessary for all beneficiaries. These include one influenza virus (flu) vaccine per year, all pneumococcal pneumonia vaccines, and a three-part Hepatitis B vaccine administered over a six-month period for high-risk individuals. Part B also covers any vaccinations provided for the treatment of an injury or after exposure to an external disease, such as getting cut by a rusty nail or being exposed to rabies.
The Hepatitis B vaccine is only covered under Part B for high-risk individuals. Part D may cover the vaccine for low to moderate-risk individuals, but even if the vaccine is covered, the administration of it may not be. Inform your clients that it is always a good idea to check with their plan and health care provider before proceeding with treatment to make sure they are aware of any possible associated costs.
Part D covers most other vaccinations; however, covered vaccines vary from company to company. Since PDPs are only offered through private insurance companies and not through the federal government, each company may choose to leave certain vaccines out of their formulary. A formulary is a list of covered medications. Most companies still include all vaccines Medicare beneficiaries should need, but it is always a good idea to check your provider’s formulary before visiting a doctor’s office or clinic.
Though many places offer vaccines, the best choice is usually through a primary care physician or a local pharmacy. If you have Original Medicare, make sure that the pharmacy is enrolled in Medicare to ensure they can submit the claim without charging you upfront. If you have a Medicare Advantage plan through a third-party company, make sure that the provider or pharmacy is in-network. If not, you could end up paying for the vaccine out of pocket or receiving a costly surprise medical bill!
We hope this information on what vaccines are covered by Medicare is helpful to you.
Empower Brokerage is dedicated to helping you educate your clients on the insurance they need and staying on top of their health. Whether it’s through webinar training, one-on-one calls, seminars, or marketing plans. We want you to be successful. Give us a call if you have any questions at 888-539-1633.