Medicare Part B (medical insurance) statutorily covers four recommended vaccines for Medicare beneficiaries: influenza, pneumococcal polysaccharide (Pneumovax 23, Merck), pneumococcal conjugate (PCV20, Prevnar 20, Pfizer, or PCV15, Vaxneuvance, Merck), and hepatitis B (for patients at high or intermediate risk). Medicare Part B does not cover other adult vaccinations (e.g., Tdap and zoster) unless they are directly related to the treatment of an injury or direct exposure to a disease, such as anti-rabies treatment or tetanus prevention due to an injury. In the absence of injury or direct exposure, preventive immunization against diseases such as tetanus, pertussis, or diphtheria is not covered by Part B.
Medicare Part D plans (outpatient prescription drug insurance) generally cover vaccines that Part B does not cover (for example Tdap and zoster), as long as the vaccine is recommended by the Advisory Committee on Immunization Practices (ACIP). Payment for Part D-covered vaccines and their administration is currently determined solely by the patient’s prescription drug plan. The Inflation Reduction Act of 2022 will require Medicare Part D plans to begin covering ACIP-recommended adult vaccinations without a deductible or copay beginning later in 2023.