Medicare Payment and Immunizations
Cost of Flu, Pneumonia, Shingles, and Other Vaccines for Adults
Vaccines can be costly both to the provider and the patient who receives it. If a self-pay, check prices in various locales first but don’t put off life saving immunizations because of lack of Medicare coverage.
Flu Shot Coverage and Cost
Influenza is an annual recommended injection and is paid for by Medicare part B. Depending where it is gotten, the price when self paid usually ranges form $19 to $30. Influenza is not a live vaccine (the one that is sniffed is live but not for anyone over 49 years of age) so it does not transmit the virus.
H1N1 shot (Swine Flu) isn’t officially out but presumably Medicare will cover it. It may need a second booster to make it effective.
The Pneumonia Shot
Pneumovax is recommended for everyone 65 and older. If one is immune suppressed, has a lung disease, or is a smoker it should be given earlier. Then a second shot is given after age 65 if more than 5 years have passed since the first. At this time it is not advised to have more than 2 pneumovax injections in a lifetime. Medicare pays for the shot at age 65. If on Medicare prior to age 65 and a pneumonia shot is recommended, it is also covered. Otherwise its costs somewhere between $50 and $80 depending on the type of vaccine administered.
Shingles Vaccine, Coverage and Cost
The recently developed shingles vaccine is to prevent the herpes family infection called herpes zoster. This is a form of painful reinfection of the virus for those who had chicken pox. It is recommended for those age 60 and older. If on Medicare and prescribed, Medicare part D helps pays for this. That means it is treated as a drug by payment. Because it has stringent refrigeration rules many small practices don’t carry it but send the patient to a health department or clinic that does handle the vaccine. Without a prescription and Medicare part D, its costs vary between $150 to over $200 to receive it
Hepatitis B Shot
The immunization to prevent the contagious blood and body fluids form of hepatitis infection is a series of 3 shots. It is recommended to high-risk adult groups although all school children are now required to have it. If the healthcare provider recommends this vaccine to a Medicare recipient, Medicare will pay it for. Otherwise it costs $65-$85 per shot.
Hepatitis A Shot
This is the immunization for food or water borne hepatitis. This virus is considered less virulent than hepatitis B but there have been deaths from it after people ate at picnics or restaurants. It is a 2 shot series and usually not paid for by Medicare unless part of an illness. It usually costs around $85- $90. Both hepatitis series are a good idea for travelers regardless of who pays for it.
Tetanus Vaccine Coverage and Cost
This is the immunization to prevent lockjaw, a bacterial infection. Should there be a medical need for it such as a contaminated wound (the classic example is stepping on a rusty nail), Medicare part B will pay for it. But if it is simply time for the 10-year booster, it is a self-pay. Average costs may vary somewhere between $35-$45.
Not all injections are immunizations. Medicare payment varies on medical need for such shots as B12, osteoporosis or testosterone injections. Furthermore, if the clinic itself does not accept Medicare, it is moot whether Medicare pays for the immunization or not. Always inquire about acceptance of the insurance and whether it is a complete payment or only partial.
hepatitis and pneumovax
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