Five Vaccines Covered by Your Medicare Plan

Five Covered Vaccines You Need
Healthy aging is about more than just regular exercise and good nutrition. You also need to protect your body from illnesses that can harm your immune system.

“As we get older, our bodies don’t regenerate the way they did when we were younger,” says Christa Winterhalter, PharmD, manager of Pharmacy Programs at Highmark. “We can’t fight
off infections as easily or as often, so we need to take preventive actions to remain healthy.”

The Centers for Disease Control and Prevention (CDC) recommends specific vaccines for people 65 and older. These vaccines help prevent influenza (flu), pneumonia, shingles, tetanus and, most recently, COVID-19. Getting vaccinated is quick, easy, and affordable. Just make sure the administering doctor or clinic is covered by your Medicare plan.  

Here’s everything you need to know about these five Medicare-covered vaccines:

1. COVID-19 vaccine

COVID-19 is a disease caused by the SARS-CoV-2 virus. It’s spread through droplets from your mouth or nose when you breathe, cough, sneeze, or speak.

In most people, COVID-19 causes respiratory symptoms that feel similar to a cold or flu. However, adults over the age of 50 run a higher risk of severe illness from COVID-19, including
breathing issues that can result in hospitalization or death.

The CDC recommends everyone over the age of 5 get vaccinated, especially older adults. People over 65 who are fully vaccinated show a 94% reduced risk of hospitalization from the virus. “The COVID-19 vaccine will help protect you and your loved ones from getting infected and spreading the virus,” Winterhalter says.

Medicare Part B covers all COVID-19 vaccines. The number of doses you need depends on which vaccine you get:  

  • Two doses of Pfizer-BioNTech vaccine given three weeks apart.
  • Two doses of Moderna vaccine given four weeks apart.
  • One dose of Johnson & Johnson’s Janssen vaccine.

Booster shots, which give you further protection against the virus, are also available. You
should get your booster at least five months after your primary vaccinations if you received the Pfizer or Moderna vaccines, or two months after receiving the Johnson & Johnson vaccine.

People who are moderately or severely immunocompromised are at a higher risk of illness and death from COVID-19. The CDC recommends that these individuals get vaccinated if they’re age 5 or older, and get a booster if they’re age 12 or older. Because the immune response from the vaccine may differ in immunocompromised people, the CDC also recommends a slightly different dosing schedule for this group. If you’re immunocompromised, make sure to talk to your doctor about when to get vaccinated.

2. Flu vaccine

The flu vaccine guards against influenza, a contagious respiratory illness. Adults over the age of 65 are at greater risk for serious complications from the flu, including pneumonia. This population also accounts for more than 70% of flu-related deaths.

Unlike the other vaccines listed here, you should get the flu shot every year. The CDC recommends getting the shot in September or October, before flu season starts.

Medicare Part B covers all flu vaccines. You may have the option of a regular-dose shot or a specialized shot designed for people over the age of 65. “All the flu vaccines are effective,” Winterhalter says. “The most important thing is that you get one each year.”

3. Pneumococcal vaccine

The CDC recommends that you get two separate pneumococcal vaccines if you are over the age of 65. Both protect against the bacteria Streptococcus pneumoniae, a strain of bacteria known to cause pneumonia, meningitis, and bloodstream infections.

Medicare Part B covers both pneumococcal vaccines. According to Winterhalter, adults age 65 and older should get a dose of Prevnar 13® first, followed by a dose of Pneumovax® one year later. However, you may have received the Prevnar vaccination during your 50s. In that case, you won’t need to get it again.

“Pneumonia is not seasonal,” Winterhalter says. “As soon as you hit the age range to get these vaccines, you really should.”

4. Shingles vaccine

Shingles is a painful, viral infection triggered by the same virus that causes chickenpox. According to the CDC, 1 in 3 people develop shingles in their lifetime — and half of those people are over the age of 60.

The shingles vaccine, covered by Medicare Part D, is recommended for adults over the age of 50. In addition to preventing infection, the vaccine also provides strong protection against a type of nerve pain called post-herpetic neuralgia (PHN), the most common complication from shingles.

“Shingles is a disease that mostly targets older adults,” Winterhalter says. “Do not procrastinate on getting this vaccine. There is no advantage to waiting.”

5. Tetanus (Td) vaccine

Tetanus is a life-threatening disease caused by bacteria contracted from dirt, dust, or
feces. The bacteria is not spread from person to person. Instead, it enters the body through broken skin — often from a burn or stepping on a nail. 

Most likely, you received your first tetanus vaccine when you were younger. DTaP, DT, and Tdap all offer protection from tetanus, while Tdap provides additional protection against diphtheria and pertussis (whooping cough).

Medicare Part D covers the booster tetanus (Td) vaccination, which adults should get every 10 years. Since it’s so infrequent, the tetanus vaccination can be easy to forget. But it’s crucial that you stay on track with your doses, especially if you’re managing wounds or other injuries that can make you more susceptible to tetanus.

“It’s important to get a tetanus booster every 10 years to lessen the risk of complications if wound management is needed,” Winterhalter says.

Let Highmark help with finding your Medicare plan

Schedule a personal consultation with a Highmark Medicare advisor or call 866-320-8539 , 7 days a week, 8 a.m. - 8 p.m. (ET), (TTY users call 711)

This site works best with the latest version of Edge, Firefox, Chrome or Safari.

Highmark Choice Company, Highmark Senior Health Company, and Highmark Senior Solutions Company are Medicare Advantage plans with a Medicare contract. HM Health Insurance Company is a PDP plan with a Medicare contract. Enrollment in Highmark Choice Company, Highmark Senior Health Company, Highmark Senior Solutions Company, and HM Health Insurance Company depends on contract renewal.

Health benefits or health benefit administration may be provided by or through Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Senior Health  Company, Highmark Senior Solutions Company, or Highmark Health Insurance Company, all of which are independent licensees of the Blue Cross Blue Shield Association.  All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.

Y0037_22_3628_M