Immunization

Medicare Part B and Part D both cover certain immunizations. Although the delineation of coverage is clear, there are some exceptions where a vaccine could be covered under either plan.  

When billing for prophylactic immunizations, the following always applies:

• Influenza and pneumonia immunizations are always paid under Part B.  
  (These are never covered under Part D.)  
• Shingles immunizations are always paid under Part D.  
  (These are never covered under Part B.)  

Part B covers two categories of immunizations (prophylactic and injury/disease-related) and the benefit pays everything associated with the vaccination in a single claim, including ingredient cost, dispensing fee and injection or administration fee. Medicare will pay for immunizations in various venues: at a pharmacy, a clinic or a physician’s office.  

Activity associated with administering Part D vaccinations are also bundled into a single claim. However, incidental activity, such as an office visit, may involve additional cost-share to the patient. 

Medicare Part B covers influenza immunizations in full and some organizations provide the influenza immunizations free of charge while others may charge for an influenza immunizations. Because not all venues will file the Part B claim on the patient’s behalf, the patient may have to pay cash for the influenza immunizations, and then seek reimbursement from Medicare Part B. 

It’s important to remind these patients that Medicare Part B covers annual influenza immunizations at 100 percent (no copay or deductible) and that they must submit a completed claim form and receipt to their Medicare Part B insurance plan to obtain reimbursement. The claim must be submitted under Part B because influenza immunizations and pneumonia vaccinations are never paid under Part D.  

Although shingles vaccinations are a prophylactic measure, these vaccinations are always covered under Part D. There is no coverage for this vaccination under Part B.