Your Group Medicare plan provides coverage for vaccines, but that coverage depends on the specific vaccine and where you get it.
Knowing how your coverage works may save you from paying for vaccines out of pocket.
At your provider’s office the Medicare Part B portion of your plan pays for the following vaccines at your provider’s office and at the pharmacy:
- Influenza (flu) vaccine—once per season
- Pneumococcal vaccines
- Hepatitis B vaccines for persons at increased risk of hepatitis
- Vaccines directly related to the treatment of an injury or direct exposure to a disease or condition, such as rabies and tetanus.
At a network pharmacy the Medicare Part D portion of your plan covers all commercially available vaccines—except for those covered by Part B—as long as the vaccine is reasonable and necessary to prevent illness.
Important information for your pharmacist
Let your pharmacist know to use BIN 015581 and PCN 03200000 when filling your prescription for items covered under Part D.
Get vaccines like the ones listed below at a network pharmacy. If you get them at your doctor’s office, you’ll pay the full cost of the vaccine out of pocket.
Here are some common vaccines that you should get at your pharmacy, not from your doctor.
- Tdap (If you need a tetanus shot due to injury, Medicare Part B will cover that from your doctor.)
- Hepatitis A
Because vaccines are covered differently at the provider’s office and the pharmacy, you may want to call first to understand how your insurance covers a specific vaccine.
Call the Customer Care number on the back of your Humana member ID card or sign in to MyHumana.com.