Vaccines play an important role in maintaining good health. But, not all vaccines are intended for everyone. Your first step should always be to check with your health care provider to find out what vaccines he or she recommends for you. Then, if you’re uncertain, call your insurance provider or Medicare office to see if you are following their rules for covering the cost of these vaccines.
Here are some general guidelines:
Medicare Part B pays for one seasonal flu shot with no co-pay. If you have a Medicare Advantage plan, you will not be charged for a flu shot if you visit an in-network provider.
Medicare Part B does not pay for the shingles vaccine. However, all Medicare Part D plans are required to cover the vaccine and its administration.
Part D plans have very specific rules about how to get the shingles vaccine. For example, a plan may only cover the injection if you get it in a health provider’s office and not a pharmacy. Some plans might also ask that you pay your doctor upfront for the vaccine and then seek reimbursement.
Ask your Part D plan about its specific coverage rules for the shingles vaccine.
Pneumococcal (pneumonia) vaccine
Medicare Part B pays for one pneumococcal vaccine with no co-pay. Under certain circumstances, Medicare will also pay for a second type of vaccine for certain high-risk individuals. Medicare Advantage members cannot be charged for the shot if they receive it from an in-network provider.
Your doctor or other health care provider may recommend services more often than Medicare covers. Or, they may recommend services that Medicare does not cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand the costs of your care.
Have more questions on Medicare? Join me for Getting Started with Medicare. We cover all the basics you should know before you enroll in Medicare. For a complete list of dates and times, go to www.mutskoinsurance.com/seminars.The class is for educational purposes only and no plan specific benefits or details will be presented.
If you have questions on insurance, please contact me at 440-255-5700.