How vaccine coverage works

Medicare Part B & Part D cover different vaccines.

  

Vaccination is a safe and effective way of protecting people against harmful diseases and infections. There are many different vaccines available to protect you and to help you stay healthy. Vaccines are covered under either Medicare Part B (your medical benefits) or Medicare Part D (your prescription drug benefits) services.

Below are examples of vaccines that are covered differently:

Part B Vaccines

  • Influenza, or flu
  • Pneumococcal
  • Hepatitis B if you are at intermediate or high risk of getting hepatitis B

Part D Vaccines

  • Shingles
  • Meningococcal
  • Td/Tdap
  • Other commercially available vaccines not covered under Part B

You can view the full list of covered Part D vaccines in our drug list.

  

Costs to expect

Part B Vaccines

There is no copay for the 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

If you get a Part D vaccine at an in-network pharmacy, your copay for each injection is:

Platinum and Gold card members$40
Sharp HealthCare former employees$40
City of San Diego retirees (SDPEBA)$20
CalPERS retiree$20

For your convenience, we recommend this option when getting a Part D vaccine.

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, then submit a Part D prescription reimbursement claim for Sharp Health Plan to pay our share of the cost. You’ll get a refund for the approved amount less the normal copay for the vaccine (including administration). The Part D prescription claim form and other forms are available here for download.

  

Recommended vaccines, in general

We want to highlight three vaccines that are important for keeping you healthy. Talk to your primary care physician or pharmacist to see if these vaccines are right for you.

Influenza vaccine (flu shot)

  • Anyone can get the flu. Everyone 6 months and older should get the flu shot once every year.
  • Protecting yourself from the flu helps prevent spreading it to others. The flu is a virus that can be spread from coughing or sneezing.
  • Flu viruses change from year to year. Even if you got the flu shot before, you still need to get it every year to stay protected.
  • Adults 65 years and older are at higher risk of getting serious flu complications.

Pneumococcal vaccine

  • Pneumococcal disease is an infection caused by the streptococcus pneumoniae bacteria. The bacteria can cause pneumonia, ear and sinus infections, blood infection and meningitis.
  • All adults 65 years and older should get the pneumococcal shot.
  • If you are 65 years and older and have certain chronic conditions — diabetes, smoking, alcohol use disorder, and heart, lung or liver disease, for example — an extra pneumococcal shot may be recommended for you. Talk to your doctor to see if an extra shot is right for you.

Shingles vaccine

  • Herpes zoster, commonly known as shingles, is a painful skin rash caused by the Varicella-zoster virus (VZV). VZV is the same virus that causes chickenpox.
  • There are two shingles vaccines: Shingrix (2-shot) and Zostavax (1-shot). Shingrix is recommended because it works better to prevent shingles.
  • Adults 50 years and older should get two Shingrix shots, 2 to 6 months apart.
  • If you previously received the Zostavax shot, you should get revaccinated with Shingrix.

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: 6/01/2021
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