What you should know about adult immunizations

Each year, National Immunization Awareness Month reminds us about the importance of getting recommended vaccinations throughout our lives. Vaccines help our bodies fight disease-causing germs (pathogens) and familiarize our immune systems with certain pathogens so that our body will know what to do if infected by that pathogen in the future. We know that our immune system naturally weakens with age, so getting recommended vaccines helps protect us as we go forth and live boldly.

What vaccines should you get if you are 65 and older? Let’s break down the most important vaccines and how Medicare covers each one.

1. Influenza vaccine (flu shot)

Influenza, also known as “the flu” can be a pretty serious disease. Every flu season is different, and the annual seasonal flu vaccine is the best way to protect against the flu – illness, hospitalization, and death. The flu vaccine protects the body against whatever influenza viruses researchers indicate will be most common during the upcoming season. The best time to get vaccinated is by the end of October each year.

Original Medicare covers one influenza (flu) vaccine per season under its Part B benefit. A Medicare Advantage plan covers all immunization services that are included under Medicare Part B.

2. Shingles vaccine

You may remember having chickenpox as a kid – that itchy, blister-like rash on your skin caused by the varicella-zoster virus. This same virus causes shingles, less contagious than chickenpox, but it can lead to long-term pain after the virus passes and severe side effects. There is a vaccination for shingles, and it can help prevent shingles and any related complications. Definitely talk to your doctor about whether or not the shingles vaccine is right for you.  

Original Medicare does not cover the shingles vaccine. Coverage for the shingles vaccine is available if you purchase Medicare Part D coverage or enroll in a Medicare Advantage plan with a Part D benefit (MAPD).

3. Pneumococcal (pneumonia) vaccine

Pneumococcal disease is the name given to any infection caused by streptococcus pneumoniae, a type of bacteria. You may be more familiar with the types of infection such as pneumonia, meningitis, bacteremia, sinus infection or a middle ear infection. If your immune system is weakened and/or if you’re managing a chronic condition, you may have a higher risk of infection or face more severe side effects. Good news – a vaccine can help! A pneumonia vaccine consists of two shots given about a year apart.

Original Medicare covers two different pneumococcal vaccines. The first is covered at any time, and a different, second vaccine is covered if it is given at least one year after the first. A Medicare Advantage plan covers all immunization services that are included under Medicare Part B.

4. Hepatitis B vaccine

Hepatitis B is a liver infection caused by the hepatitis B virus. For many, infection is a short-term illness, but for others it can lead to long-term and chronic infection including serious life-threatening health issues like cirrhosis or liver cancer. Most of us were vaccinated against hepatitis B as babies, but if you’re not sure, it definitely doesn’t hurt to check! Talk to your doctor to help determine your risk of getting hepatitis B.

Original Medicare covers hepatitis B vaccinations if you are at medium or high risk under its Part B benefit. A Medicare Advantage plan covers all immunization services that are included under Medicare Part B.

5. COVID-19 vaccine

Because the risk of severe illness from COVID-19 increases with age, the CDC recommends adults 65 and older receive the COVID-19 vaccine. If you have not been vaccinated yet, contact your county or state health department, ask family member or friend to help you, or ask your doctor or pharmacist where and when vaccine appointments are available. You can find a vaccine near you by visiting vaccines.gov. 

Medicare covers all FDA-authorized COVID-19 vaccines at no cost to you. This means no copayment, deductible, or administrative fee from a provider. A Medicare Advantage plan covers all immunization services that are included under Medicare Part B.

If you have any more questions about vaccines and which ones are right for you, talk to your doctor. If you want to check and see what vaccines an MA plan covers, refer to the Evidence of Coverage (EOC), drug list (formulary) or contact your plan directly.

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