Random things pop up every now and then with my clients and sometimes the situation feels like something more people should know about. I had some clients who went to their physician’s office to get a vaccine. After, they were told their insurance wouldn’t pay for it because it should have been received at a pharmacy. Not all insurance plans will require you get the vaccine at a pharmacy so please check with your insurance before you are vaccinated.

Here are some general guidelines regarding how vaccines are categorized.

Medicare Part B (Medical) covers vaccines and vaccine administration for: Flu, Pneumonia, Hepatitis B (for people at high and intermediate risk), COVID-19, and certain reasonable and necessary vaccines to treat an injury or exposure to a disease

Part D (Prescription) plans cover all commercially available vaccines when they’re reasonable and necessary to prevent illness, except those covered by Part B. Examples are the shingles, respiratory syncytial virus (RSV), and tetanus-diphtheria-whooping cough vaccines. If a new vaccine isn’t on your Part D plan’s formulary, you can ask your physician if he or she can request vaccine coverage through the formulary exception process.

Part D plans cover vaccine administration costs as part of each vaccine’s negotiated price, including: Dispensing fee, Vaccine administration fee, and Vaccine ingredient cost.

How can you know if your vaccine will be covered under Part B or
Part D? Here is an example:

If a patient gets a tetanus vaccination because of an accidental puncture wound, it’s a Part B-covered vaccine. However, if the patient gets a tetanus booster shot, unrelated to injury or illness, it’s a Part D- covered vaccine.

Just remember, if you are ever questioning your coverage, it’s best to call your plan to find out the best way to get your vaccine. If you have any other questions, please let me know.

www.JenniferBellBenefits.com * 720.665.6015