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Adult Vaccination Resources








Resources for Adult Vaccination Insurance and Payment						Print
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			Private Insurance Vaccine CoverageMedicare Coverage and PaymentMedicaid CoverageMilitary InsurancePatients without Insurance
		
Many healthcare professionals want to immunize their patients with recommended vaccines. These resources are designed as a starting point to help your practice better understand vaccine coverage.
Private Insurance Vaccine Coverage
All Health Insurance Marketplace plans and most other private insurance plans must cover the following list of vaccines without charging a copayment or coinsurance when provided by an in-network provider. This is true even for patients who have not met a yearly deductible. Doses, recommended ages, and recommended populations for these vaccines vary:
A new recommendation for serogroup B meningococcal vaccination of those age 16 through 23 years was published in the MMWR dated October 23, 2015. Health plans are required to cover new vaccine recommendations without cost-sharing in the next plan year that occurs one year after this date. Patients should check with their insurance provider for details on whether there is any cost to them for this vaccine.
Hepatitis A
Hepatitis B
Herpes Zoster
Human Papillomavirus
Influenza
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Tetanus, Diphtheria, Pertussis
VaricellaCheck with your patient’s insurance provider for details of coverage. Under the Affordable Care Act, insurance plans that cover children now allow parents to add or keep adult children on their health insurance policy until they turn 26 years old.
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Medicare Coverage and Payment
Medicare covers initial pneumococcal vaccine and different, second pneumococcal vaccine one year after the first is administered, effective February 2, 2015. See Modifications to Medicare Part B Coverage of Pneumococcal Vaccinations[3 pages].
Medicare Part B will pay for the following vaccines:
Influenza (flu) vaccine
Pneumococcal vaccines
Hepatitis B vaccines for persons at increased risk of hepatitis
Vaccines directly related to the treatment of an injury or direct exposure to a disease or condition, such as rabies and tetanusThe Medicare Immunization Quick Reference[6 pages] provides billing information about influenza, pneumococcal, and hepatitis B vaccines.
Medicare Part D plans identify covered vaccines through formularies. *Part D plan formularies must include all commercially available vaccines (except those covered by Part B)*. A new preventive vaccine may not specifically appear in the formulary, but the plan may still cover the vaccine. Contact the plan to find out about coverage.
Medicare Part D or Medicare Advantage Plan Part C that offers Medicare prescription drug coverage may also have coverage for
Zoster
MMR
TdapLearn more about vaccine payments under Medicare Part D. [2.1 MB, 8 pages]

Medicaid Coverage
Most State Medicaid agencies cover at least some adult immunizations but not all offer vaccines at the ACIP standards.
Learn more about Medicaid and vaccines.

Military Insurance
For your patients who serve in the military or are a military dependent eligible for TRICARE, vaccines are covered according to the CDC recommended schedule.

Patients without Insurance
If your patients do not currently have any health insurance, let them know that they can visit www.HealthCare.gov to learn more about health coverage options.
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							Last Reviewed:  May 2, 2016						Source: 	National Center for Immunization and Respiratory Diseases
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