How vaccine coverage works

It’s now common knowledge that COVID-19 vaccines are $0 — but what about other vaccines? There are many different vaccines available to protect you and help you stay healthy. With Medicare, your coverage depends on the vaccine and how you get it.

Medicare Part B (your medical benefits) and Part D (your prescription drug benefits) cover different vaccines. The following are examples of vaccines that are covered differently:

Part B Vaccines

  • COVID-19
  • Influenza (flu)
  • Pneumococcal
  • Hepatitis B, if you are at intermediate or high risk of getting hepatitis B

View the full list of covered vaccines in your drug list.

Vaccine costs to expect

Part B Vaccines

There is no copay for the COVID-19, flu, pneumococcal and hepatitis B vaccines.

Part D Vaccines

When you get a Part D vaccine, what you pay depends on who gives you the vaccine.

  • At an in-network pharmacy

    For your convenience, we recommend this choice when getting a Part D vaccine. It’s a good idea to check your online drug list, or formulary, ahead of your visit so you know what costs to expect.

  • At your doctor’s office

    If you get a Part D vaccine at your doctor’s office, you must pay for:

    • Office visit copay
    • The entire cost of the vaccine and the administration fee

    After you pay at your doctor’s office, send a Part D prescription reimbursement claim to Sharp Health Plan so we can pay our share of the cost. You’ll get a refund for the approved amount less the normal copay for the vaccine (including administration).

TIP: Download the Part D prescription claim form and other forms at the website listed on your member ID card.

  

Sharp Direct Advantage is offered by Sharp Health Plan. Sharp Health Plan is an HMO with a Medicare contract. Enrollment with Sharp Health Plan depends on contract renewal. Read the full disclaimer.

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Page Last Updated: 10/21/2021
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