Have you gotten a vaccine recently? A new report shows that most Medicare plans don’t cover them.

Precription Drug Plans
No Prescription Drug Plans use a Vaccine Tier that would cover vaccinations, so most beneficiaries pay cost-sharing fees for vaccines.

  • Average copay: $35 – $70
  • Average coinsurance: 28% – 39%
  • Actual out-of-pocket: $14 – $103

Medicare Advantage-Prescription Drug plans
A small amount of MAPD plans use a Vaccine Tier. in 2015, about 3% of MAPD plans had a Vaccine Tier. In 2012, it was about 2%. Among these plans, the Shingles shot, Zostavax, was the most often covered.

  • Average copay: $42 – $54
  • Average coinsurance: 16% – 27%
  • Actual out-of-pocket: $10 – $72

Actual out-of-pocket prices were based on current costs for vaccines. If  a beneficiary hasn’t reached they would pay the full cost of the vaccine, which can range from $38 – $276.

Why are the payments for beneficiaries have such a wide range? 
The range of prices shows the rage of tiers that Prescription Drug and MAPD plans use for vaccines.


These are the vaccines listed above: 

Boostrix: Booster shot- Tetanus, Diptheria, Whooping cough
Zostavax: Shingles
Varivax: Chicken Pox
Menomune: Meningitis
Havrix: Hepatitis A
VAQTA: Hepatitis A
Energix-B: Hepatitis B
Twinrix: Hepatitis A & B
Tenivac: Booster shot- Tetanus, Diptheria



Tom Says:

“This is something we should all be telling our Congressmen: that all Medicare plans should have Vaccine Tiers to cover vaccinations.”

See the report by Avalere Health here.

For more, read a blog about the report on Modern Healthcare.

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