Every Vaccine Medicare Covers: Part B, Part D, and What Costs Nothing

Vaccination is among Medicare's most unambiguously positive preventive benefits, and many Medicare beneficiaries do not realize how comprehensive their vaccine coverage actually is. Several vaccines are covered under Part B with zero cost-sharing, while others fall under Part D with varying copays depending on the plan. Understanding which vaccines fall under which benefit, where to go to pay nothing, and a billing quirk that can generate unexpected charges helps you stay current on vaccinations without overpaying.

Bryce's Take

I mention vaccines every time I do an Annual Wellness Visit review with a client. Shingrix in particular, it is now free under Part D, it requires two doses, and many Medicare beneficiaries have not completed the series because they paid out of pocket before the pricing changed and never went back for the second dose. Both doses are free now. Get both.

Vaccines covered under Medicare Part B at zero cost

Medicare Part B covers several vaccines at no cost-sharing, no deductible and no 20% coinsurance, when administered by a Medicare-enrolled provider. These include the influenza (flu) vaccine annually, COVID-19 vaccines and boosters, pneumococcal vaccines (Pneumovax and Prevnar, typically given as a two-vaccine series), and hepatitis B vaccine for individuals at medium or high risk. For these vaccines, you pay nothing if the provider accepts Medicare assignment and bills correctly. These vaccines can be administered at your physician's office, a health department, or a Medicare-enrolled pharmacy.

Vaccines covered under Medicare Part D

Other vaccines are covered under Part D drug plans rather than Part B. Part D-covered vaccines include shingles (Shingrix), RSV (Abrysvo, Arexvy, mRESVIA), hepatitis A, Tdap (tetanus, diphtheria, pertussis), meningococcal vaccines, and other vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). Beginning in 2023, the Inflation Reduction Act required Part D plans to cover ACIP-recommended vaccines with no cost-sharing. As a result, the shingles vaccine, previously a significant out-of-pocket cost, is now free under Part D plans.

The shingles vaccine: now free

Shingrix, the two-dose shingles vaccine, is recommended for adults 50 and older and requires two doses two to six months apart. Before 2023, it could cost hundreds of dollars under Medicare Part D. The Inflation Reduction Act eliminated cost-sharing for ACIP-recommended adult vaccines under Part D, making Shingrix available at no cost under any Part D plan. This applies whether you have standalone Part D or a Medicare Advantage plan with drug coverage. Get both doses, one is not sufficient for protection.

Where to get vaccines under Medicare

Part B vaccines can be administered at Medicare-enrolled physician offices, clinics, and pharmacies. Major pharmacy chains, CVS, Walgreens, Walmart, Kroger, and others, are Medicare-enrolled and can administer and bill Part B for flu, COVID-19, and pneumococcal vaccines at no cost. Part D vaccines are also frequently available at pharmacies through the Part D benefit. When going to a pharmacy for vaccines, bring both your Medicare card and your Part D or Medicare Advantage plan card so the pharmacy can bill the correct benefit.

The billing trap: vaccines and the office visit

An important warning about a common billing scenario: if you receive a vaccine during an office visit for a medical problem, the office visit is billed under Part B with standard cost-sharing, but the vaccine itself should still be billed at zero cost-sharing under Part B. Some practices incorrectly bill the vaccine as part of the office visit rather than as a separate preventive service. If you receive a bill for vaccine administration during an office visit, verify that the vaccine and office visit were billed separately. This billing distinction matters for your cost-sharing.

Keeping track of recommended vaccines

The CDC publishes a vaccine schedule for adults 65 and older that specifies which vaccines are recommended, how many doses, and at what intervals. Key vaccines for Medicare-age adults include annual flu, annual COVID-19 updated booster, two-dose pneumococcal series (if not previously completed), two-dose Shingrix series, RSV vaccine (one dose for adults 60+), and hepatitis B series (if not previously completed). Your physician can review your vaccination history and recommend what you may have missed.

Bryce Casson

Licensed Independent Medicare Broker

Bryce Casson is an independent Medicare insurance broker who works with every major carrier. He does not represent any single insurer, which means his recommendations are based on what actually fits each client's situation, not on commissions or quotas.