Vaccines covered under Medicare prescription drug plans (Part D) and Medicaid became free starting in 2023. This means there are no co-payments—or deductibles to meet—for any vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP).¹ 

The list of vaccines recommended by ACIP includes the vaccines for influenza (flu), COVID-19, shingles, respiratory syncytial virus (RSV), and Tdap (tetanus, diphtheria, and pertussis, also known as whooping cough).

In the past, many older adults have gone without life-saving vaccines, like shingles and Tdap, because their budgets couldn’t stretch to cover out-of-pocket expenses. With the elimination of cost sharing, vaccines are more accessible to the people who need them to stay healthy.

“Older adults face unique health risks that make them more vulnerable to severe illness and hospitalization,” said Kathleen Cameron, former Senior Director of the NCOA Center for Healthy Aging. “Having no Medicare or Medicaid out-of-pocket costs helps more people get vaccinated in a timely manner and protect themselves from preventable diseases—without added financial stress.”

Learn which vaccinations are fully covered by Medicare and Medicaid and which ones are recommended for older adults.

Are vaccines covered under Medicare Part B or D?

Medicare Parts B and D cover different vaccines:

• Vaccines covered under Part B include the annual influenza vaccine, pneumococcal shots, and the COVID vaccine. Hepatitis B shots are cost-free for anyone at medium or high risk of contracting the virus.
• Part D-covered vaccines include those for Tdap, RSV, and shingles.

No matter which coverage you have, all adult vaccines recommended by ACIP are fully covered at no cost to you. If you have Part B, the pharmacy or provider administering the vaccine must accept Medicare assignment. If you have Part D, you must generally receive the vaccine from a pharmacy or provider within your plan’s network.

If you don’t meet plan requirements, you may get billed for the service—or you may have to pay up front and request reimbursement later.

Does Medicare pay for Shingrix?

Medicare covers the complete cost of Shingrix, the vaccine that helps prevent shingles. This viral infection, which causes a painful skin rash, affects about 1 out of 3 people in the U.S. And your risk of getting shingles—and complications from shingles—increases with age.²

The Centers for Disease Control and Prevention (CDC) recommends that healthy adults age 50 and older get two doses of Shingrix separated by two to six months. Vaccination is also recommended for some adults age 19 years and older who have compromised immune systems. People who are immunocompromised can receive their second dose of Shingrix one to two months after the first dose.

The Shingrix vaccine is more than 90% effective at keeping you from getting shingles and from developing long-term nerve pain.²

Is the RSV vaccine covered by Medicare?

Yes, Medicare covers the respiratory syncytial virus (RSV) vaccine if you fall within ACIP recommendation guidelines. RSV is a common respiratory virus that affects the lungs and breathing passageways. It typically causes mild, cold-like symptoms. Like COVID and the flu, RSV is highly contagious.

While most people recover from RSV within a week or two, some are more likely to develop serious illness and complications. This includes older adults and infants age six months or younger. RSV symptoms usually start within four to six days after getting infected with the virus and include fever, congestion, runny nose, sore throat, and a barking cough.

What vaccines do older adults need?

For adults age 50 and older, ACIP recommendations include the influenza, shingles, Tdap, pneumococcal, and updated COVID vaccine. A single-dose RSV vaccine is recommended for adults age 60 and older, based on shared decision-making between the patient and their provider. A hepatitis B vaccine is advised for all adults age 60 and older with risk factors.

To learn more about the vaccinations you may need to stay healthy, visit the CDC website. Be sure to discuss your immunization needs with your doctor, since recommendations can vary depending on your overall health and underlying medical conditions.

Find articles on important vaccines, Medicare coverage and costs, and more at the NCOA’s Health & Wellness resource hub.

Sources

1. Centers for Medicare & Medicaid Services. The Inflation Reduction Act Lowers Health Care Costs for Millions of Americans. Oct. 5, 2022. Found on the internet at https://www.cms.gov/newsroom/fact-sheets/inflation-reduction-act-lowers-health-care-costs-millions-americans

2. Centers for Disease Control and Prevention. Get the Shingrix Vaccine if You Are 50 or Older. Found on the internet at https://www.cdc.gov/shingles/multimedia/shringrix-50-older.html