Generally, vaccines are available at no cost to members. Coverage is different depending on the location where the vaccine was given.
Some vaccines have age restrictions. Please consult the Medication Prior Authorization Criteria for details before administration.
Medicare Part B (administered in a clinic or retail pharmacy setting) covers –
Medicare Part D (administered in a retail pharmacy) covers –
Medicare Part D-covered vaccines should generally be administered at a pharmacy. Pharmacies are set up to easily bill Medicare Part D.
Most medical providers are not set up to bill Medicare Part D. If providers administer the vaccine in a clinic or other provider facility, the patient will typically be faced with a higher bill than if had they received the same vaccine at a pharmacy.
For more information, see the Medicare Part D Vaccines and Vaccine Administration
Fact Sheet at cms.gov/Medicare/Prevention/