Medicare provides many services and supplies to recipients who qualify due to age or disability, including preventive care that can help you maintain your health and wellness. Vaccinations are often associated with children’s care, but there are some vaccines that adults need later in life.
What is the Tdap Shot?
Tdap stands for tetanus, diphtheria and pertussis. Immunization is intended to prevent these serious diseases. Tetanus, sometimes referred to as lockjaw, and diphtheria are rare in the United States, according to the Centers for Disease Control and Prevention. Pertussis, otherwise known as whooping cough, causes distressing coughing episodes, which can lead to other more serious complications. The three diseases result from bacteria; diphtheria and pertussis spread from one person to another while tetanus makes its entrance through cuts, scratches or wounds on the body. The CDC touts the success of the Tdap vaccine in disease prevention but also cautions about side effects. It is critical to talk to your doctor about potential risks based on your personal health history.
Medicare Benefits for Vaccinations
As a reminder, Medicare Part A covers the cost of care in hospitals, skilled nursing facilities and hospice, and in some cases, at home. Medicare Part B covers the cost of physician services, outpatient care, medical equipment and preventive visits. Part D is for drug coverage. Neither Part A nor Part B cover the cost of the Tdap vaccine. Medicare suggests that recipients of Medicare benefits interested in this vaccine reach out to their drug plan provider to inquire about vaccinations covered under Part D. This is also true for the shingles shot. There are a few immunizations that are considered to be medical benefits that fall under Medicare Part B, such as pneumonia and flu shots, and Hepatitis B shot for those at medium or high risk.
Part D Vaccination Coverage
Whether you are enrolled in Part D or in Part C with a Medicare Advantage plan that includes outpatient prescription drugs, your provider’s customer service department should be able to clarify how the cost of the Tdap vaccine is covered. To prepare, it may help to understand how this generally works so that you know what questions to ask.
Part D vaccination coverage is comprised of two parts: Prescription medication and administration. The prescription is the vaccine medication itself. The administration refers to the medical practitioner giving you the vaccine. The distinction is important because some plans have separate coverage for these components.
What you pay may depend on where you receive the medication and who administers it to you. The possible scenarios that illustrate this are when you buy the vaccine at the pharmacy and have it administered on-site; get the vaccine at the doctor’s office where you receive the shot; or buy the vaccine at the pharmacy, and bring it to your physician who then administers it to you. Your responsibility for payment may vary across these situations from coinsurance and co-payment to the entire amount upfront, which you would then submit for reimbursement.
Medicare Part D: Medicare Prescription Drug Coverage