Medicare Advantage Members
Drug Coverage – Part D Vaccine Information
Did you know that you can save money by getting your vaccines in the right location. Most vaccines (and the cost to get them) are covered under your Medicare Prescription Drug (Part D) benefit.
Examples of vaccines covered under the Part D benefit include:
- Zoster (Shingles) vaccine
- Tetanus Diphtheria (Td) vaccine
- Tetanus Diphtheria Pertussis (Tdap)
Costs You More
Getting your vaccination in a clinic: If you get a Part D vaccine in the doctor’s office, you have to pay them for it. Afterwards, you can submit a claim to Quartz Medicare Advantage yourself. If eligible, you will be reimbursed the amount you paid less your normal copayment for the vaccine (including administration) less any difference between the amount the doctor charges and what we normally pay. (If you get “Extra Help,” we will reimburse you for this difference.) For more information, see Chapter 6, Section 8 of your Evidence of Coverage (EOC) document.
Costs You Less
Getting your vaccination in a network pharmacy: Go to a network pharmacy that has pharmacists who administer vaccines. Please contact Customer Service or view the Provider Directory for a list of network pharmacies in your area that are certified to administer your Part D vaccine.
If you don’t have Quartz Medicare Advantage Part D:
If you didn’t choose to have Part D coverage, that means your Part D vaccines are not covered. However, a few vaccines are covered with Quartz Medicare Advantage Part B. These vaccines may be covered in full and examples include:
- Hepatitis B vaccine (if you are high or moderate risk)
- Influenza vaccine
- Pneumococcal vaccine
- Tetanus vaccines necessary for the treatment of an illness or an injury that has occurred.