Immunizations – Medicare Advantage (Part B)

Medicare Advantage plans provide coverage for seasonal influenza, pneumococcal, hepatitis B, and Coronavirus Disease (COVID-19) vaccines and their administration as preventive immunizations. Qualified members can receive these services with no cost-sharing.

Other vaccines such as anti-rabies treatment, tetanus antitoxin or booster vaccine, botulin antitoxin, antivenin sera, or immune globulin are covered under Part B only when directly related to the treatment of an injury or direct exposure to a disease or condition.

Part D will generally cover those vaccines not available for reimbursement under Part B when administration is reasonable and necessary for the prevention of illness. Please refer to member’s formulary for list of covered Part D vaccines.

For more detailed information or billing requirements, please refer to the following posted CMS guidance:

• Immunizations – Medicare Advantage Billing Guidelines
• Medicare Advantage Member Drug Formularies
• Medicare Benefits Manual Ch 15 50.4.4.2 – Immunizations
• Medicare Claims Manual Ch 18 10.1 Pneumococcal Pneumonia, Influenza Virus, Hepatitis B, and Coronavirus Disease (COVID-19) Vaccines and Administration [PDF]
• CMS Medicare Part B Drugs/Vaccine Payment

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