Staying up to date on your vaccinations is one of the most important things you can do to take care of your health.
There’s a lot of focus on the COVID-19 vaccine right now. It can be easy to forget about routine vaccinations like the flu, shingles, and pneumococcal pneumonia.
The flu kills as many as 60,000 people in the U.S. every year and sends as many as 810,000 people to the hospital. Pneumococcal pneumonia causes around 150,000 hospitalizations.
And while shingles isn’t nearly as dangerous, it can be very painful! It can also cause permanent vision loss and other complications.
Getting vaccinated for these and other diseases could save your life, or at least keep you from getting seriously ill. Vaccinations also prevent the spreading of viruses to others who may be more vulnerable. So while you may feel that you don’t need a certain vaccination, getting yourself vaccinated could help save the life of someone you love.
But here’s what I want to point out: it matters where you get your vaccinations. Some vaccines are covered under Medicare Part B, also known as your medical insurance. And for individuals with a prescription drug plan, some are covered under Medicare Part D. This difference can affect your out-of-pocket costs as well as where it makes the most sense to get vaccinated.
Medicare Part B Vaccines
These vaccinations are covered under Medicare Part B (medical insurance):
- Influenza (flu shot)
- Pneumococcal pneumonia
- Hepatitis B (for intermediate or high-risk individuals)
In addition, these other vaccinations are covered to treat certain injuries, or if you’ve been directly exposed to a particular disease or condition:
- Botulin antitoxin
- Antivenin sera
Part B vaccinations are available at no cost! You can get them at your doctor’s office, or see if your in-network pharmacy carries them.
Note: If you get other services besides the vaccine shot during your doctor’s visit, a copay may apply for those other services.
If you choose an out-of-network pharmacy, you may have to pay out of pocket and then submit a claim for reimbursement. In some cases, the amount of that reimbursement may be less than what you paid at the pharmacy.
Medicare Part D Vaccines
Here are the vaccinations that are covered under Medicare Part D (prescription drug coverage):
- Human papillomavirus (HPV)
- Measles, mumps, rubella (MMR)
Suppose you don’t meet the requirements for Part B coverage I’ve described above. That is, you’re not getting vaccinated because of a specific injury or disease exposure. In that situation Part D will also cover:
- Botulin antitoxin
- Antivenin sera
Part D vaccinations do have a cost-share. And that varies depending on where you get vaccinated.
I recommend getting Part D vaccines at an in-network pharmacy, not at a doctor’s office. Why? Because in-network pharmacies usually have a lower cost-share amount.
If you get Part D vaccines at a doctor’s office, your cost-sharing amounts can vary, and you may have to submit for reimbursement. In some cases the amount of the reimbursement may be less than what you paid at your doctor’s office.
What Screenings and Vaccinations Should You Get?
Getting your recommended vaccinations is one way to stay healthy. But certain health screenings from your doctor can be just as important.
Preventive screenings can make it possible to catch various conditions while they’re easier to treat. That includes anything from certain types of cancer to glaucoma, osteoporosis, abdominal aortic aneurysms, diabetes, or depression. Catching these diseases early could prevent serious health problems or even save your life.
But how are you supposed to keep track of what screenings or vaccinations you might need? That’s easy! Just visit Independence Blue Cross’s Preventive Care Guidelines resource at tools.ibx.com/preventive-services.
Put in your gender and age, and this helpful tool will give you a list of recommended screenings and vaccinations.
I hope you find that these tips help you stay healthy while getting the most out of your benefits.
Website last updated: 3/22/2021
Independence Blue Cross offers Medicare Advantage plans with a Medicare contract. Enrollment in Independence Medicare Advantage plans depends on contract renewal.
Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East and QCC Insurance Company — independent licensees of the Blue Cross and Blue Shield Association.