Medicare covers the hepatitis A vaccine under specific conditions, particularly through Part D for those at risk. However, there are important exceptions and changes coming in 2026 that beneficiaries should be aware of.
Understanding Medicare’s coverage for hepatitis vaccines is crucial for seniors, especially as the rules are stricter than many expect. With significant changes on the horizon, including no-cost coverage for the hepatitis A vaccine starting in 2026, it’s essential to navigate the eligibility criteria and exceptions to ensure you receive the necessary vaccinations.
Key Takeaways
- Medicare Part D will cover the hepatitis A vaccine at $0 cost starting in 2026.
- Part B does not cover the hepatitis A vaccine unless it is related to treatment for injury or exposure.
- Adults at increased risk per CDC recommendations qualify for the hepatitis A vaccine under Medicare.
- No out-of-pocket costs for the hepatitis A vaccine will exist under Part D in 2026, eliminating previous costs of around $34.
- All CDC-recommended adult vaccines will be covered by Medicare Part D with zero cost-sharing starting in 2026.
Related questions people ask
- What is the hepatitis B vaccine?
- Is there a vaccine for hepatitis B?
- How can you get hepatitis B?
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- How do you get hepatitis B?
- How much does the hepatitis B vaccine cost?
- Is the hepatitis B vaccine covered by insurance?
- Is the hepatitis B vaccine covered by Medicare?
- Does Medicaid cover the hepatitis B vaccine?
- Does Medicare cover the hepatitis B vaccine?
- What vaccines are covered by Medicare Part B?
- Where can I get a hepatitis B vaccine?
- Where can I get a hepatitis B vaccination?
- How often do you need the hepatitis B vaccine?
- What is the cost of the hepatitis B vaccine without insurance?
- What is the cost of the hepatitis B vaccine with insurance?
- What is the hepatitis B vaccine series?
- What are the types of hepatitis vaccines available?
- Are there alternatives to the hepatitis B vaccine?
- What is the eligibility for receiving the hepatitis B vaccine?
Understanding Medicare Coverage for Hepatitis A and B Vaccines
Medicare Part D Coverage for Hepatitis A Vaccine
Medicare Part D is set to cover the hepatitis A vaccine, such as HAVRIX and VAQTA, at no cost starting in 2026. This coverage is particularly beneficial for individuals considered at risk for hepatitis A, B, or C, ensuring that all CDC-recommended adult vaccines are accessible without any cost-sharing.
Medicare Part B Coverage for Hepatitis B Vaccine
While Medicare Part B covers hepatitis B shots for eligible individuals based on their risk factors, it does not extend coverage to the hepatitis A vaccine unless it is directly related to the treatment of an injury or exposure. This distinction is important for beneficiaries to understand as they assess their vaccination needs.
Cost Implications for Hepatitis Vaccines Under Medicare
No Out-of-Pocket Costs for Hepatitis A Vaccine
Starting in 2026, beneficiaries will face no copay, deductible, or out-of-pocket costs for the hepatitis A vaccine under Medicare Part D. This change eliminates the estimated prior cost of around $34 per patient, making it more accessible for those who need it.
Key Exceptions to Medicare Vaccine Coverage
Limitations on Hepatitis A Vaccine Coverage
It’s crucial to note that Medicare Part B only covers the hepatitis A vaccine in cases of injury or direct disease exposure, rather than for preventive measures. Additionally, hepatitis B coverage under Part B is specifically for members deemed to be at moderate to high risk, highlighting the need for beneficiaries to understand their individual circumstances.
Eligibility Criteria for Hepatitis Vaccines Under Medicare
Who Qualifies for Hepatitis A and B Vaccines
To qualify for the hepatitis A vaccine, adults must be at increased risk according to CDC recommendations. For the hepatitis B vaccine, individuals who have an unknown vaccination history or are considered medium to high risk, such as those living with someone who has hepatitis B, are eligible.
Access for Medicare Part D Enrollees
The hepatitis A vaccine will be available to Medicare Part D enrollees, particularly recommended for adults with identified risk factors. Furthermore, members of CDPHP Medicare Advantage can access this coverage at no cost through their Pharmacy Customer Care services, ensuring that they receive the necessary vaccinations without financial burden.
Recent Updates to Medicare Vaccine Coverage Policies
Changes Effective in 2026
Significant changes are on the horizon for Medicare vaccine coverage, as starting in 2026, Medicare Part D will require coverage of all ACIP-recommended adult vaccines, including the hepatitis A vaccine, with zero cost-sharing. Additionally, expansions from the Inflation Reduction Act have already made Part D vaccines free since 2023, fully effective for all recommended vaccines by 2026.
Practical Tips for Navigating Medicare Vaccine Coverage
How to Get More Information
For those seeking more information about Medicare Part D vaccine coverage, contacting Pharmacy Customer Care at (866) 289-2319 is recommended. It’s also advisable to confirm eligibility and coverage details with healthcare providers based on individual age, risk factors, and vaccination history.
Implications of Medicare Coverage for Hepatitis Vaccines
Understanding the benefits of Medicare coverage for hepatitis vaccines is essential for seniors, particularly as it applies to at-risk individuals. With the upcoming changes in 2026, all recommended adult vaccines will be available at no cost to beneficiaries, ensuring that essential vaccinations are accessible and affordable.