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Vol. 13, Issue 23  • November 17, 2014

How does Medicare cover preventive service vaccines?

Dear Marci,

My doctor told me that Medicare Part B will pay for me to get certain vaccines as preventive care, and that I would not have to pay for these vaccines. I’m especially concerned about the flu vaccine, since it is now flu season. Can you explain how Medicare covers these preventive services vaccines?

- Victor (San Antonio, TX)

Dear Victor,

Medicare Part B covers three vaccines as part of preventive care services: the flu vaccine, the pneumonia vaccine, and the hepatitis B vaccine. These vaccines are covered by in full, whether you have Original Medicare—the traditional program administered directly by the federal government—or a Medicare Advantage plan. Preventive care vaccines are an important part of staying healthy, and it is important to discuss these vaccines with your doctor.

The flu vaccine is covered once per flu season. The flu season typically runs from October through April. Therefore, Medicare may cover a flu shot twice in one calendar year. For example, if you get a flu shot in February 2014 for the 2013-2014 flu season, you can get another flu shot in November 2014 for the 2014-2015 flu season. Original Medicare will pay for the flu shot anywhere you receive it, as long as you get it from a Medicare provider. If you have a Medicare Advantage plan, your plan cannot require that you get a referral for the vaccine, but you may be required to use providers in the plan’s network.

The pneumonia vaccine is covered in full by Medicare once in your lifetime. However, in rare cases, Medicare will cover this shot more than once in a lifetime. If you are at high risk for pneumonia, meaning that you have an immunodeficiency, Medicare may cover this shot in full once every five years. Speak with your doctor if you think you are considered high risk for pneumonia. Medicare Part B covers the pneumococcal vaccine for pneumonia.

Medicare will also cover the entire cost of the hepatitis B vaccine if you are considered at medium to high risk for the disease. Some examples of individuals who are at medium to high risk for hepatitis B are people with End-Stage Renal Disease (ESRD), hemophiliacs, and those healthcare professionals who have contact with bodily fluids during their work. Speak with your doctor if you think you are at risk for hepatitis B. If you are at low risk for the disease, you can still get the hepatitis B vaccine, but it will be covered by your Part D plan, and you will likely have to pay a copay.

If you have Original Medicare, the best way to avoid additional charges is to see a health care provider who accepts Medicare assignment when receiving these vaccines. To avoid additional charges if you have a Medicare Advantage plan, check with your plan to make sure you follow their rules about receiving vaccines.

-Marci

Health Tip
With the end of Daylight Savings Time, the days are shorter and often darker. For some people, this can trigger a type of depression known as Seasonal Affective Disorder (SAD). People with SAD can experience exhaustion, lethargy, and may struggle to carry out their daily routines. SAD affects up to 5 percent of the population, and is connected to a reduction in natural light exposure due to shortened days. This can cause a brain chemical imbalance.

To reduce your risk for Seasonal Affective Disorder and to promote general health during the fall and wintertime, take the following steps:

  • Spend time outside each day during daylight hours, approximately 30 minutes.
  • Let light into your home by keeping it well-lit, especially by opening curtains and blinds to let sunlight in.
  • Exercise regularly, as this releases endorphins and can help to give your body more energy.

These tips can help with Seasonal Affective Disorder, and can help to increase energy levels during the winter. If you find that you are experiencing these symptoms over a period of time, seek help from a mental health professional.

Click here to read more about Seasonal Affective Disorder from HealthDay News.

Need to Know
Fall Open Enrollment is here!During Fall Open Enrollment (October 15-December 7), you may make changes to your Medicare health and drug coverage. If you need help deciding your Medicare coverage for 2015, call the Medicare Rights Center’s free, national consumer helpline at 800-333-4114.

Dear Marci is a biweekly e-newsletter designed to keep you — people with Medicare, social workers, health care providers and other professionals — in the loop about health care benefits, rights and options for older Americans and people with disabilities.

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