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Marci’s Medicare Answers

August 2013

Dear Marci,

Does Medicare cover shots and vaccines?

—Job

Dear Job,

Yes, Medicare covers some shots and vaccines. However, the way Medicare covers them depends on which shot or vaccine you need.

Medicare Part D, also known as the Medicare prescription drug benefit, covers most shots and vaccines that you get. However, Medicare Part B, the medical insurance part of Medicare, may cover certain shots and vaccines in some situations. Specifically, Part B covers vaccines to prevent the flu, pneumonia and hepatitis B. Keep in mind that Part B will cover your hepatitis B shot only if you are at medium-to-high risk for hepatitis B. If you are at low risk for hepatitis B, your shot will be covered under Part D.

Medicare Part B also covers shots, after you have been exposed to a dangerous virus or disease. For example, if you step on a rusty nail, Medicare Part B will cover your tetanus shot to treat the spread of the tetanus bacteria.

All other shots or vaccines, other than the ones mentioned above, are generally covered under Part D. Medicare Part D plans must include all commercially available vaccines on their formulary, or list of covered drugs, including the vaccine for shingles. Before you get a shot or vaccine, check with your Part D plan to see where you should get your shot at the lowest cost.

—Marci

Dear Marci,

I am signing up for Medicare for the first time. What is the “Welcome to Medicare” preventive visit?

—Carrie

Dear Carrie,

The “Welcome to Medicare” visit is a one-time, preventive visit with a doctor or health care provider that occurs within the first 12 months of your enrollment into Medicare Part B, the medical insurance part of Medicare. The “Welcome to Medicare” visit is not a routine, head-to-toe physical exam. Rather, it is a preventive visit designed to map out your health care needs and create a preventive plan to keep you healthy.

During your “Welcome to Medicare” visit, your doctor or health care provider may:

  • Review your medical and social history
  • Check your height, weight and blood pressure
  • Create a personalized plan to prevent disease based on your current health and risk factors
  • Counsel you on potential risk factors and educate you on other preventive services covered by Medicare

If you have Original Medicare, the traditional Medicare program administered directly through the federal government, then you may pay nothing for the visit as long as you see a doctor who accepts Medicare and takes assignment. A doctor who takes assignment accepts the Medicare-approved amount for a service as full payment. If you have a Medicare Advantage plan, also known as a Medicare private health plan, you should contact your plan to see what rules and costs apply. All Medicare Advantage plans must cover the same preventive services that Original Medicare does and will generally do so as long as you follow the plan’s rules.

Keep in mind that costs may apply if you receive additional services or screenings during the “Welcome to Medicare” preventive visit. It may be helpful to ask your doctor whether you have only received the Medicare-covered preventive visit or if any additional services were provided.

—Marci

Dear Marci,

I have Medicaid and I am about to become eligible for Medicare. Can I have both Medicare and Medicaid?

—Billy

Dear Billy,

Yes, if you are eligible for both Medicare and Medicaid, you can have both. Medicare is the federal health insurance program for disabled individuals and people 65 years or older. Medicaid is a federal and state health insurance program for people with low incomes. While both programs are different, they can work together to provide comprehensive health care coverage. People who have both Medicare and Medicaid are oftentimes referred to as dual-eligibles.

If you receive health care services covered by Medicare, Medicare will pay first on those health care services and Medicaid may pay for any remaining costs. If you receive health care services that are strictly excluded from Medicare coverage, Medicaid may pay for those health care services depending on your state Medicaid program’s benefits and rules.

For general information on Medicare coverage of health care services or items, you can go online and visit www.medicare.gov or call 800-MEDICARE. For more information on your state’s Medicaid benefits, you should contact your state Medicaid program directly.

—Marci

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Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. To subscribe to “Dear Marci,” MRC’s free educational e-newsletter, click here.
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Last Modified: 09/19/2013 14:08:42
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