Medicare@work
A blog about Medicare. What you and your employees need to know
Take a Shot- Medicare Has You Covered

Author: Lora Drummond
Medicare Transition Specialist
Posted: 08/31/2020
How does your employer health benefit plan cover vaccines?
My sister-in-law’s milestone birthday this year brought her the Big 5-0 and a case of Shingles – affecting her eye! I knew that Shingles generally afflicts people over 50 but we were particularly concerned her occurrence could lead to more serious complications. So I did some research on the virus for my education since I am older than her and then headed to CVS for a vaccine.
Based on my recent experience. I decided to share some basics about how Medicare would cover various vaccines for beneficiaries.
Vaccines are important for maintaining good health. The Centers for Disease Control and Prevention (CDC) recommends the following vaccines for adults 65 and older:
- Flu
- Tdap or Td (tetanus, diphtheria, pertussis)
- Shingles (zoster)
- Pneumococcal (pneumonia)
- Chickenpox (if you did not get this vaccine as a child)
So, how would some of the more common vaccines be covered by Medicare?
According to Medicare, a vaccine can be submitted under Part B or Part D depending on several factors. Then, depending on the vaccine type and your coverage, the plan may cover only a portion, apply a deductible first, or not cover the vaccine at all. How do you determine if the vaccine you need is covered?
Confirming coverage requires a bit of research, so it’s important when considering any vaccine to review what Medicare Part B covers and the Part D drug benefit coverage you are enrolled in before receiving your vaccine. No one likes cost surprises.
Some general vaccine info:
Original Medicare Part B (Medical) is billed and there is little or no copay for:
- Hepatitis B vaccine (for patients at high or intermediate risk)
- Influenza virus vaccine
- Pneumococcal pneumonia vaccine
- Vaccines directly related to the treatment of an injury or direct exposure to a disease or condition For instance, if a beneficiary needs a tetanus vaccination due to an accidental puncture wound, it would be covered under Part B. However, simply needed a booster shot of a tetanus vaccine, unrelated to injury or illness, would be submitted under Part D for coverage consideration.
- Reference www.medicare.gov and your drug plan for a full list of what Medicare covers.
Part D (Prescription Drug Plans) may or may not provide benefit coverage for other vaccines and with varying member responsibility:
- *Important*- Confirm your vaccine coverage details with your particular Part D insurance carrier before receiving your vaccine.
- Part D plans will list covered drugs and vaccines through their specific drug formularies- not all plans cover all vaccines and some may apply deductible first.
- Part D plans may have special rules, such as prior authorization, step therapy, and quantity limits before coverage applies.
- Vaccines may include an ‘administration fee’ with the vaccine cost that should be disclosed by the person administering the vaccine.
- Sometimes the beneficiary pays for the vaccine and then submits a paper claim to Part D plan for reimbursement up to the plan’s allowable charge. If the amount the physician charges is different from the plan’s allowable charge, a balance may remain that the beneficiary would not be reimbursed for.
- Reference www.medicare.gov and your drug plan for a full list of what Medicare covers.
We have your employees covered when transitioning to Medicare to explain their options.
Medicare@ Work provides the teams, tools, and technology to guide your employees to Medicare when it makes sense to do so.
Create a compliant Medicare benefit support plan.
Give your employees personal guidance from a team of experts that will follow them after they retire.
Ready to get started?
Check out our blog weekly for new resources, and helpful tips and tricks to build your Medicare transition strategy.
Your Medicare Transition Partner
– Lora
Subscribe to Medicare@work
Other Posts from Medicare@work
Stay Tuned! Medicare Help for Business is Here
Don’t adjust your dial! Our Medicare help for businesses is now more accessible than ever. Stay tuned to your favorite social media sites for links to enjoy helpful topics for guiding employees with their options regarding Medicare. When folks turn 65, they have more healthcare choices. We are here to help!
Medicare Stew Series – Medicare Supplements -Like Peas and Carrots
Medicare Stew – A series simply explaining the main ingredients of Medicare to help your employees. Read about Medicare Supplements (Medigap) Plans.
Medicare Stew – Medicare Advantage Plans
Medicare Stew – A series simply explaining the main ingredients of Medicare to help your employees. Read what Medicare Advantage Plans are.
Medicare Stew – What is Part D
Medicare Stew – A short series simply explaining the main ingredients of Medicare to help your employees. Read about Medicare Part D.
Medicare Stew – What is Original Medicare
Medicare Stew – A short series simply explaining the main ingredients of Medicare to help your employees. Read what Original Medicare is.
Tackle 2022 by Reducing your Workload
Ready to reduce your workload in 2022? Add a team of Medicare experts and education to your benefits team. We make Medicare@Work 123easy!
Emergency – That Snowbank and Medicare
You are on a vacation with your family in another state. How does your Medicare Advantage plan work in an emergency?
Gratitude – Wrapping Up the Year
Thank you from The Medicare Architects for trusting us with helping your employees transition stress-free from their group plan to Medicare.
Advice – Stop Your HSA When You Get Part A
If your employees enroll in Medicare while still working neither they or their employer can continue to contribute to their HSA.
Celebrate – 65 Candles in 2022? Groovy!
Turning 65 in 2022? Here are are some thing to consider if you will keep working past your birthday and want to keep your employer plan.
Contact Us
(800) 568-1095
Brought to you from Scottsdale, AZ
Get Started

Recent Comments