Congress eliminated cost-sharing for all vaccines covered under Medicare Part D.
Medicare now covers the entire cost of the shingles vaccine and others recommended by the Advisory Committee on Immunization Practices.
Older adults with Medicaid benefits also will receive recommended vaccinations free of charge.
The Inflation Reduction Act of 2022 contained an important piece of money-saving health care news for older adults: Vaccines covered under Medicare prescription drug plans (Part D) and Medicaid are free in 2023.
This means there are no more co-payments—or deductibles to meet—for any vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP).1 This list includes the vaccines for shingles and Tdap (tetanus, diphtheria, and pertussis, which is also known as whooping cough).
The Adult Vaccine Access Coalition (AVAC), whose members include the National Council on Aging (NCOA), called the bill “an investment in the future health, well-being, and economic security of our seniors and those in marginalized communities.” AVAC has been an advocate for cost-free vaccines since its founding in 2015.2
Even in non-inflationary times, many older adults have gone without health-preserving vaccines, like shingles and Tdap, because their budgets couldn’t stretch to cover out-of-pocket expenses.3
“Every year, thousands of adults die and thousands more suffer serious health problems from vaccine-preventable diseases—due in part to the complicated and costly landscape faced by Medicare and Medicaid recipients when seeking access to vaccines,” AVAC said in a media release.2
So, what does this new vaccine landscape look like? Here are some of the top takeaways about the vaccinations now fully covered by Medicare and the cost-saving benefits to you.
When did the free vaccines become available?
As of Jan. 1, 2023, out-of-pocket costs for all ACIP-recommended vaccines were eliminated for people with Medicare Part D.4 Out-of-pocket vaccine costs for most people enrolled in Medicaid will be eliminated beginning Oct. 1, 2023.1
Are vaccines covered under Medicare Part B or D?
Vaccines have been covered in different ways under Parts B and D.
Part B vaccines have been cost-free. These include the annual influenza vaccine, pneumococcal shots, and the COVID-19 vaccines. Hepatitis B shots are cost-free for anyone at medium or high risk of contracting the virus.
For Part D vaccines, including the Tdap and shingles vaccinations, people have generally had to share the cost through co-payments, coinsurance, or other expenses. Some Medicaid enrollees have incurred out-of-pocket expenses for recommended vaccinations, too.5 Because of the Inflation Reduction Act, Part D vaccines are now treated on the same cost-free basis as those under Part B.
Will doctors’ offices and pharmacies know about these changes?
The Centers for Medicare and Medicaid Services (CMS) keeps health care providers informed of plan changes. But to avoid billing headaches, the Medicare Rights Center recommends people with Medicare coverage make sure the health care provider or pharmacy administering the vaccine will bill their Part D plan. Before getting a vaccine at a doctor’s office or pharmacy, ask the provider to call your Part D plan first to find out if they can bill your Part D plan directly.
What vaccinations will Medicare now fully cover?
No-cost coverage continues for the flu, pneumococcal, and COVID-19 vaccines, and hepatitis B for people whose doctors recommend it. In 2023, the Tdap and shingles vaccines join the list of no-cost vaccinations.
The ACIP Adult Immunization Schedule recommends these vaccines for older adults with additional risk factors or other health needs: hepatitis A, varicella, meningococcal A, C, W, Y (MenACWY); meningococcal B (MenB); and haemophilus influenzae type b (Hib).6
Those vaccines are also now cost-free.
Does Medicare pay for Shingrix in 2023?
This viral infection, which causes a painful rash, affects about 1 out of every 3 people in the United States. And your risk of getting shingles—and complications from shingles—increases with age.7
Shingrix is a two-dose vaccine; you’ll get the second dose 2-6 months after the first. The vaccine is more than 90% effective at keeping you from getting shingles and from developing long-term nerve pain.8
What vaccines do older adults need?
Be sure to discuss your vaccination needs with your doctor, since recommendations can vary depending on your overall health and medical conditions.
For adults 50 and older, the ACIP recommends the influenza, shingles, Tdap, and COVID-19 vaccines. It adds the pneumococcal vaccine for people 65 and up.7
To learn more about the vaccinations you may need, try the Adult Vaccine Assessment Tool to receive a personalized list of recommendations.
1. Centers for Medicare & Medicaid Services. The Inflation Reduction Act Lowers Health Care Costs for Millions of Americans. Oct. 5, 2022. Found on the internet at https://www.cms.gov/newsroom/fact-sheets/inflation-reduction-act-lowers-health-care-costs-millions-americans
2. Adult Vaccine Access Coalition. AVAC Welcomes Passage of Inflation Reduction Act to Help Close Longstanding Gaps in Vaccination Coverage in Medicare and Medicaid. Aug. 12, 2022. Found on the internet at adultvaccinesnow.org/home/avac-welcomes-passage-of-inflation-reduction-act-to-help-close-longstanding-gaps-in-vaccination-coverage-in-medicare-and-medicaid/
3. Avalere. Fewer Seniors Get Vaccinated as Their Out-of-Pocket Costs Increase. July 19, 2018. Found on the internet at https://avalere.com/insights/fewer-seniors-get-vaccinated-as-their-out-of-pocket-costs-increase
4. Centers for Medicare & Medicaid Services. Reduced Drug Prices, Enhanced Medicare Benefits Under the Inflation Reduction Act Frequently Asked Questions (FAQs). Oct. 5, 2022. Found on the internet at https://www.cms.gov/files/document/10522-external-faqs-about-inflation-reduction-act.pdf
5. Medicaid.gov. Quality of Care Vaccines. Found on the internet at https://www.medicaid.gov/medicaid/quality-of-care/quality-improvement-initiatives/quality-of-care-vaccines/index.html
6. Centers for Disease Control and Prevention. Adult Immunization Schedule. Feb 2, 2022. Found on the internet at https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html#table-age
7. Centers for Disease Control and Prevention. Get the Shingrix Vaccine if You Are 50 or Older. Dec. 9, 2020. Found on the internet at https://www.cdc.gov/shingles/multimedia/shringrix-50-older.html