Medicare Coverage for Tetanus Shots and Other Vaccines

Does Medicare Cover a Tetanus Shot

Medicare coverage extends to number of vaccinations, although some are only covered by Medicare Part D. Part B of Medicare covers many of the most common immunizations, such as the yearly flu vaccine. Medicare usually uses medical necessity to determine what it covers, which means that some high-risk individuals can get more comprehensive vaccine coverage.

This article explains coverage details for a number of vaccines, so you know what to expect before you go in for your shot.

What part of Medicare covers vaccines?

Medicare Part B covers many of the more common vaccines. In total, it covers shots for the flu, pneumonia, and COVID-19 at 100%, which means you will pay nothing out-of-pocket, even if you haven’t reached your yearly Part B deductible. Part B also covers the Hepatitis B vaccine for those who are at high risk. (We explain this in more detail in the section, "When does Medicare cover the Hepatitis B shot?")

Medicare Part D covers numerous additional vaccines, including the tetanus shot. Although these Medicare prescription drug plans are usually used primarily for prescription drug coverage, they also cover a variety of vaccines that Original Medicare won’t pay for.

Medicare Advantage plans, also known as Part C, offer the same coverage as Original Medicare. Some plans may also cover booster shots, such as the tetanus vaccine. Coverage varies from plan to plan. It may also differ if you are at high risk for the condition a particular vaccine protects you from, such as Hepatitis.

Medicare Part A does not offer any coverage for vaccinations.

How much do vaccines cost?

The actual cost of each vaccine varies, and if you are insured you will almost never pay the full amount. However, the Centers for Disease Control and Prevention (CDC) provides a full list of vaccine costs per dose, along with additional information about each vaccine. This can be useful to know in advance if you don’t have coverage for a specific vaccine.

Medicare coverage for the flu shot

Medicare covers the flu vaccine in full each year. You will be able to get one shot per flu season and will pay nothing at all out-of-pocket if your doctor accepts assignment. If you aren’t sure if your doctor accepts Medicare assignment, reach out to them to find out.

You can also look for Medicare-approved providers here.

Medicare coverage for the pneumococcal vaccine

The pneumococcal vaccine is also covered in full by Medicare. Just like the flu vaccine, you will not pay anything if your doctor accepts assignment.

The pneumococcal vaccine requires two shots that are given at least a year apart. You can get your first shot at any time, and can then schedule the next shot with your doctor for at least a year later. Each shot protects against a different type of bacteria, which is why you need both to be fully immunized against pneumonia.

Medicare coverage for the COVID-19 vaccine

Medicare fully covers the vaccine for COVID-19, so you pay nothing out-of-pocket. One unique feature available for this vaccine is that Medicare can pay a doctor to come to your home, still at no cost to you. You can discuss this option with your doctor, or call 1-800-MEDICARE (633-4427) to find a doctor that will come to your home. Just be careful to never give your Medicare information out over the phone unless you called Medicare directly. Anyone who calls you claiming to be from Medicare or Social Security is a thief trying to steal your information. Unless you requested a call, all communications from either Medicare or Social Security are via U.S. mail. If someone does call you claiming to be from Medicare, hang up the phone and call Medicare to report the incident.

For more information about Medicare and the COVID-19 vaccine, click here.

When does Medicare cover the Hepatitis B shot?

Medicare Part B covers the Hepatitis B vaccine, but only for those who are at a high risk. If you qualify, you will pay nothing out-of-pocket for the Hepatitis B shot. You qualify for full coverage by satisfying one of the following conditions:

  • You have hemophilia
  • You have end-stage renal disease (ESRD)
  • You have diabetes
  • You live with someone who has Hepatitis B
  • You are a healthcare worker

There may be other complications that allow you to qualify as well. Talk to your doctor to find out if they think it is necessary for you to receive this vaccine.

Does Medicare cover the Tdap shot?

Tdap is a booster shot that protects you against tetanus, diphtheria, and pertussis (whooping cough). It is commonly received every ten years or so for those with prior tetanus immunization. Tdap is the name given to the adult booster for this vaccine, while the version given in childhood is known as DtaP. Although both protect against the same diseases, Tdap is the version you’ll need.

The Tdap shot is not covered at all by Original Medicare (Parts A and B). However, it is covered by Medicare Part D. Under a Part D plan, you may have to pay a co-insurance or co-pay when you receive your vaccine. You should check with your plan to get the full details.

What part of Medicare pays for the shingles vaccine?

Medicare Part D plans also cover the shingles vaccine. This functions in the same way as the Tdap vaccine, and you have to pay a co-pay or co-insurance. You can contact your prescription drug plan for more information about your specific costs.

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Further reading

After retiring from a career as an executive travel counselor in 2006, Donna Frederick embarked on a second career as a licensed insurance agent. During that first year, many clients told Donna how overwhelmed they felt by Medicare, but that her assistance helped them finally understand the Medicare program. That experience inspired Donna to focus her efforts on educating her clients to ensure they fully understand their Medicare options. Today, Donna takes pride in providing outstanding customer service and going the extra mile to make sure each client knows all of their options and has a sound understanding of their Medicare plan, from costs to coverage and all points in between.


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