By: The My Medicare Matters Team
Coverage of preventive services is one of the most important parts of Medicare’s role in keeping people healthy. Whether reinforcing immunizations you received as a child, or preparing you for next flu season, vaccines are a key part of avoiding diseases that can prevent you from aging well. Medicare helps pay for four vaccines, each of which you should discuss with your doctor to protect yourself!
- What is the flu? The flu—or influenza—is a contagious respiratory illness that can be severe and life-threatening.
- Why is it important for older adults to get the flu shot? Older adults—even if you are healthy—are at higher risk when it comes to the flu due to age-related weakening of our immune systems, making it more difficult for us to fight off disease. For the 86% of adults 65+ who are managing a chronic condition—like diabetes or heart disease—the flu can be even more dangerous because you are more likely to develop complications or become hospitalized. Flu combined with pneumonia—a common acute condition among the aging population—is one of the top 10 causes of death for those aged 65+ in the U.S. According to the CDC, the flu vaccination is the best way to prevent the flu. To address the increased risks faced by the aging population, a higher-dose version of the flu vaccine was created specifically for older adults – talk to your doctor today about this option.
- How does Medicare cover the cost of the flu shot? The flu vaccine is a once a year, cost-free Medicare B benefit. For Original Medicare, you must use a physician or healthcare provider who accepts Medicare assignment, and for Medicare Advantage, you may have to use an in-network doctor or pharmacy.
- What is Shingles? Shingles is a painful skin rash that’s caused by the same virus responsible for chickenpox. Shingles is less contagious than chickenpox and can only be passed on to another person up until the point when the infected person’s blisters begin to scab. Even after shingles passes, long-term pain can linger.
- Why is it important for older adults to get the shingles vaccine? Researchers believe that the age-related weakening of our immune systems can trigger the “reawakening” of the dormant chickenpox virus. One in three adults contracts shingles at some point in their life—the majority of whom are 60 years or older—and the older you are when you get shingles, the more likely you are to have severe side effects, like fever, exhaustion and loss of appetite. These can lead to malnutrition, physical deterioration and/or additional infections. Whether you remember having chickenpox as a child or not, you should still talk to your doctor about getting vaccinated.
- How does Medicare cover the cost of the shingles vaccine? All Medicare Part D drug plans, or Medicare Advantage plans that include prescription coverage, typically cover the shingles vaccine. However, there is usually an out-of-pocket cost. Depending on your plan, you will either be responsible for a copayment (fixed dollar amount) or coinsurance (percentage of the vaccine’s cost). You are likely to have the least out-of-pocket expenses if you use a pharmacy in your plan’s network. Each plan has specific rules for covering the vaccine itself, as well as the administration of the injection, so it’s best to contact your insurance company directly to find out your specific out-of-pocket cost, and any rules you must follow regarding where you receive the vaccine.
- What is pneumococcal disease? Pneumococcal disease causes severe infections throughout the bloodstream and/or key organs. While you may not have heard of pneumococcal disease, you have probably heard of the conditions that result from this disease, including pneumonia (infection of the lungs), meningitis (infection of the lining of the brain and spinal cord), and bacteremia (infection of the bloodstream). Pneumococcal disease can result in deafness, brain damage, loss of limbs, and even death.
- Why is it important for older adults to get the pneumococcal vaccine? Pneumococcal disease kills 18,000 adults 65+ each year. A weakening immune system means that older adults are at greater risk, and can face more severe side effects, especially those who are managing chronic diseases.
- How does Medicare cover the cost of the pneumococcal vaccine? The pneumococcal vaccine is a cost-free benefit covered by Medicare Part B. For Original Medicare, you must use a physician or healthcare provider who accepts Medicare assignment, and for Medicare Advantage, you may have to use an in-network doctor or pharmacy.
Hepatitis B Vaccine
- What is the hepatitis B virus? Hepatitis B (or hep B) is a contagious virus that infects the liver. Acute hep B, which usually lasts a few weeks, often mimics symptoms similar to the flu, like fever and nausea. Chronic hep B is long-term, often has no symptoms at all, and can cause liver damage or death.
- Why is it important for older adults to get the hepatitis B vaccine? The liver and its function change as you age, making hep B more prevalent among older adults. Your risk of contracting hepatitis B increases if you have hemophilia, end-stage renal disease (ESRD), diabetes, or other conditions that lower resistance to infection. Acute hep B is particularly dangerous for older adults because there is no specific treatment for the symptoms.
- How does Medicare cover the cost of the hepatitis B vaccine? Medicare Part B insurance covers the full cost of the hep B vaccine(s) if a doctor determines that you are at high or medium risk of contracting the hep B virus, and the physician or healthcare provider administering the vaccine accepts Medicare assignment. Consult your doctor to determine your risk of getting hep B.
Make the most of your Medicare coverage
Getting these vaccines is an important part of healthy aging, and they also help ensure the health of your friends and family. Call your doctor today to see if these vaccines are right for your health, and then check with your Medicare provider about where you can get them and what is your expected out of pocket cost. If you know someone who may not be vaccinated, share this information with them so they can take the next step toward protecting themselves.