Before 2023, older adults with Medicare often faced high co-payments for preventive vaccines, which posed an extra financial burden for people already struggling to get by. In 2021, Medicare enrollees paid $234 million in out-of-pocket costs for recommended vaccines covered under Part D.

The Inflation Reduction Act of 2022 brought some good news for people with Medicare: Vaccines covered under Medicare prescription drug plans (Part D) and Medicaid became free starting in 2023. This means there are no more co-payments—or deductibles to meet—for any vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP).¹ This list includes the vaccines for shingles, respiratory syncytial virus (RSV), and Tdap  (tetanus, diphtheria, and pertussis, also known as whooping cough).

Why is this change so important for older adults?

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.2 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, 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?

Vaccines have been covered in different ways under Parts B and D.  

Part B vaccines have been cost-free. These include the annual influenza vaccine, pneumococcal shots, and the COVID-19 vaccines. Hepatitis B shots are cost-free for anyone at medium or high risk of contracting the virus.

For Part D vaccines, including the Tdap and shingles vaccinations, people have generally had to share the cost through co-payments, coinsurance, or other expenses. Some Medicaid enrollees have incurred out-of-pocket expenses for recommended vaccinations, too. Because of the Inflation Reduction Act, Part D vaccines are now treated on the same cost-free basis as those under Part B.

What vaccinations does Medicare fully cover?

No-cost coverage continues for the flu, pneumococcal, and COVID-19 vaccines, and hepatitis B for people whose doctors recommend it. In 2023, the Tdap, RSV, and shingles vaccines joined the list of no-cost vaccinations.

The ACIP Adult Immunization Schedule recommends these vaccines for older adults with additional risk factors or other health needs: hepatitis A, varicella, meningococcal A, C, W, Y (MenACWY); meningococcal B (MenB); and haemophilus influenzae type b (Hib).

Those vaccines are also now cost-free.

Does Medicare pay for Shingrix?

Medicare now 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.3

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.³

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 6 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 50 and older, ACIP recommends the influenza, shingles, Tdap, and updated COVID-19 vaccine. A single-dose RSV vaccine is recommended for adults age 60 and older, based on discussions between the patient and their provider. It also adds the pneumococcal vaccine for people 65 and older.

Be sure to discuss your vaccination needs with your doctor, since recommendations can vary depending on your overall health and medical conditions.

To learn more about the vaccinations you may need, try the Adult Vaccine Assessment Tool to receive a personalized list of recommendations.

Find articles on these and other important vaccines, Medicare coverage and costs, and more at the NCOA’s Health for Older Adults 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. Avalere. Fewer Seniors Get Vaccinated as Their Out-of-Pocket Costs Increase. July 19, 2018. Found on the internet at https://avalere.com/insights/fewer-seniors-get-vaccinated-as-their-out-of-pocket-costs-increase

3. 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