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I want to make sure I’m up to date on all my vaccines but am concerned about keeping my costs down. Does Original Medicare or Medicare Advantage plans cover the cost of the most common vaccines for older adults?

Vaccines play an important role in maintaining good health. But, not all vaccines are intended for everyone. Your first step should always be to check with your health care provider to find out what vaccines he or she recommends for you. Then, if you’re uncertain, call your insurance provider to see if you are following their rules for covering the cost of these vaccines. 

Here are some general guidelines:

Flu shot
Medicare Part B pays for one seasonal flu shot with no co-pay. If you have a Medicare Advantage plan, you will not be charged for a flu shot if you visit an in-network provider. 

Shingles shot
Medicare Part B does not pay for the shingles vaccine. However, all Medicare  Part D plans are required to cover the vaccine and its administration. 

Part D plans have very specific rules about how to get the shingles vaccine. For example, a plan may only cover the injection if you get it in a health provider’s office and not a pharmacy. Some plans might also ask that you pay your doctor upfront for the vaccine and then seek reimbursement. 

Ask your Part D plan about its specific coverage rules for the shingles vaccine.

Pneumococcal (pneumonia) vaccine
Medicare Part B pays for one pneumococcal vaccine with no co-pay. Under certain circumstances, Medicare will also pay for a second type of vaccine for certain high-risk individuals. Medicare Advantage members cannot be charged for the shot if they receive it from an in-network provider. 

Your doctor or other health care provider may recommend services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand the costs of your care.

Have more questions on Medicare? Join me for Getting Started with Medicare. We cover all the basics you should know before you enroll in Medicare. For a  complete list of dates and times, go to class is for educational purposes only and no plan specific benefits or details will be presented.

If changes are being made that do not suit your needs, it may be time to switch to a new plan with better coverage. Call Mutsko Insurance Services, LLC to set up a Medicare health insurance review before open enrollment ends on December 7, 2014. We are conveniently located in Mentor at 6966 Spinach Drive. Call at 440-255-5700 or email today.

Article provided by Laura Mutsko. Laura is a licensed insurance broker offering a full line of health and life insurance products, including Individual, Group and Family Health, Annuities, Long Term Care Insurance, Medicare Advantage, Medicare Supplement Plans, Medicare Part D Prescription Coverage, Vision, Dental and Life Insurance. Mutsko Insurance Services, LLC is located at 6966 Spinach Drive in Mentor, Ohio. Laura can be reached at 440-255-5700 or through email here. For more information, visit her website at or click here to view her Senior Citizen's Guide online profile.


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