Janell Sluga Medicare & Individual Health Insurance Account Executive View Bio

Lawley Medicare Solutions Learning Center:

Ask Janell!

 

QUESTION:  I regularly get vaccines like the flu shot and now the COVID vaccine. Are these free? What about COVID tests?

ANSWER: Immunizations and vaccines are covered in different ways and by different parts of your Medicare coverage. I will explain this coverage and what you should expect. It’s important to remember that, as with any medical treatment, your first question should be, “Is this appropriate for me?” Then you can consider the cost of the treatment as part of your decision-making process. Keep in mind that there are certain situations and medical conditions where a vaccine may not be recommended, so it’s essential to discuss your options with your physician.

You might assume that all vaccines and immunizations are treated the same under Medicare, but unfortunately, that’s rarely the case. Different immunizations for various diseases can often be covered by different parts of Medicare, and they can be billed and administered in different ways. Each vaccine also comes with its own health benefits and risks to consider.

The flu shot and the pneumococcal vaccine are covered under Original Medicare Part B. Both of these vaccines have been around for a long time, predating Medicare Part D Prescription Drug coverage, and they are typically free under Original Medicare and most Medicare Advantage Plans. However, there may be instances where you are charged a fee for the administration of the vaccine, as not all types of insurance cover those administration costs. Many county governments set up walk-in clinics for these vaccines, and you can also receive them in your doctor’s office.

The flu vaccine and the COVID vaccine are both annual immunizations, should you choose to receive them. The pneumococcal vaccine is not an annual vaccine; it is also covered by Medicare Part B. There are two different versions of the pneumococcal vaccine, and you should consult with your physician to determine if and when it is appropriate for you.

The most commonly used shingles vaccine is Shingrix. This vaccine is handled differently than the ones previously mentioned. The Shingrix vaccine is billed through Medicare Part D, NOT Medicare Part B. To receive the Shingrix vaccine, you must obtain a prescription/order from your doctor’s office, after which you can get the vaccine from your pharmacy. It is covered under your Medicare Part D prescription drug coverage benefit. If you have a Medicare Advantage (MA) Plan that includes prescription drug coverage, the vaccines will be covered under the Prescription Drug benefit of your MA plan. The Shingrix vaccine consists of two doses administered at specific intervals. All Medicare Part D plans fully cover the Shingrix vaccines, typically with a $0 copay.

Next, let’s talk about the COVID vaccine. Like the flu shot and pneumococcal vaccine, the COVID vaccine is covered by Original Medicare with a $0 cost. The latest updated version is now available, and you may have seen commercials encouraging you to get vaccinated. If you have had COVID recently, it is generally recommended to wait three months before getting vaccinated, and this should be discussed with your physician.

The COVID vaccine is usually administered through local pharmacies. You can find locations and make appointments via the website www.vaccines.gov. By entering your zip code, you can see pharmacy locations and schedule your vaccine at a convenient date and time. This website also allows you to search for county-run vaccine clinics, which are often held during this time of year. Many vaccine clinics are being organized in October and possibly into November, depending on your location.

Getting the COVID vaccine is certainly easier now than it was a few years ago. Regardless of your age, you can receive this vaccine if you and your physician determine it is appropriate.

Another topic of interest is COVID test kits. These kits are available to order up to four at-home tests at no cost via www.COVIDTest.gov. These kits can be ordered for any household, regardless of the ages of the individuals living there. This benefit is not provided through Medicare and is not age-specific.

If you have questions or need assistance navigating your options, don’t hesitate to reach out to the Lawley Medicare Solutions Team. You can contact Medicare Service Team Lead Gabrielle Connor at 716.849.8223, or submit an inquiry through our contact form below. We’re here to help you find the right coverage for your needs!

At Lawley Medicare Solutions, our Medicare and Individual Health Consultants are dedicated to helping you make the most informed decisions about your healthcare needs. We offer personalized service and expert advice tailored to your unique situation. Contact us today by phone or email to schedule a consultation and ensure you’re getting the best coverage for your needs.

 

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Our licensed Medicare & Individual Health Insurance team can help clients understand the details of Medicare insurance plans, assist with choosing the right benefits and coverage, and provide guidance when life events that affect health coverage occur.

For questions, concerns, or to reach Lawley Medicare Solutions, fill out the contact form below or call 716.849.8223.