Recommended Vaccines for Medicare Recipients

Dear Savvy Senior,

My husband and I recently turned 65 and would like to find out which vaccines are recommended and covered by Medicare?

     --New Beneficiaries

Dear New,

All recommended vaccines for adults, age 65 and older, should be covered by either Medicare Part B or Part D, but there are some coverage challenges you should be aware of. Here’s a rundown of which vaccines are recommended by the Centers for Disease Control and Prevention (CDC) and how Medicare covers them.

Covid-19: Even though Covid-19 is no longer a public health emergency, it can still cause severe illness, particularly in older adults. Because the Covid virus continues to mutate, new vaccines are being developed to keep pace, so the CDC recommends that all seniors stay up to date with the latest Covid vaccines, including booster shots.

All Covid-19 shots are covered 100 percent by Medicare Part B.

Flu: Considered an annual vaccination, most people of all ages receive flu shots in the fall when flu season begins. The CDC recommends seniors, 65 and older get a high-dose flu shot for extra protection beyond what a standard flu shot offers. The Fluzone High Dose Quadrivalent, FLUAD Quadrivalent and FluBlok Quadrivalent are your three options.

Annual flu shots are covered under Medicare Part B.

Pneumonia: These vaccines help protect against pneumococcal disease, which can cause pneumonia, meningitis and other infections. The CDC recommends everyone 65 and older get a pneumococcal vaccine. There are several different vaccine options available, so talk to your doctor or pharmacists to find out which is best for you or visit the CDC’s Pneumococcal Vaccination webpage at CDC.gov/vaccines/vpd/pneumo/public/index.html.

Medicare Part B covers both single dose and two-dose pneumococcal shots once in your lifetime.

Shingles: Caused by the same virus that causes chicken pox, shingles is a painful, blistering skin rash that affects more than 1 million Americans every year. All people over age 50 are recommended to get the two-dose Shingrix vaccine, which is given two to six months apart, even if you previously received Zostavax. In 2020, Shingrix replaced Zostavax, which is no longer available in the U.S.

All Medicare Part D prescription drug plans cover shingles vaccinations, but coverage amounts, and reimbursement rules, vary depending on where the shot is given. Check your plan.

Tdap: Tetanus, diphtheria, and pertussis (whooping cough) are diseases caused by bacteria that can lead to serious illness and death. Therefore, a one-time dose of the Tdap vaccine is recommended to all adults. If you’ve already had a Tdap shot, you should get a tetanus-diphtheria (Td) booster shot every 10 years.

All Medicare Part D plans cover these vaccinations.

RSV: Respiratory syncytial virus (RSV) can lead to pneumonia or bronchiolitis and can worsen other chronic conditions common among older adults, such as asthma and chronic obstructive pulmonary disease (COPD). The CDC recommends all adults, age 60 and older, talk to their doctor about getting one of the RSV vaccines (either Arexvy or Abrysvo), usually in the fall and winter months when the virus is most prevalent.

Most Medicare Part D plans cover the RSV vaccine, but not all. If your plan doesn’t cover it, you can ask for a coverage exception. You can also pay for the shot out of pocket and then follow-up with your plan to get reimbursed. If you pay for the shot upfront, your plan must pay you back.

Other Vaccinations

There are other vaccines you may need depending on your health, lifestyle or travel plans. To help you get a handle on which ones are appropriate for you, take the CDC’s What Vaccines Do You Need? quiz at www2.cdc.gov/nip/adultimmsched. Also, talk to your doctor during your next visit about what vaccinations you should get.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.