Adult Vaccines… Who pays for it?
Adult vaccines are just as important as childhood vaccines. Most often, consumers find it difficult to decipher how these vaccines are paid for. Do you need to pay for the vaccine out of pocket, or just you copay? Here are the facts about the most common vaccines for adults:
- All Adults:
- Seasonal Flu—this vaccine is paid for in full by most private insurance companies, even if you haven’t met your deductible. It is also covered by Medicare Part B. All adults should get this vaccine in the fall of every year.
- Td or Tdap— this vaccine is paid for in full by most private insurance companies, even if you haven’t met your deductible. It can also be covered by Medicare Part D plans. Tdap is needed once for all adults who did not receive it as a child, and a Td booster is needed every 10 years. Also, women should get the Tdap vaccine with every pregnancy.
- Adults 19-26
- HPV—this vaccine is paid for in full by most private insurance companies, even if you haven’t met your deductible. Human papillomavirus (HPV) can cause cervical cancer, anal cancer, and genital warts. Women aged 19-26 are encouraged to receive this vaccine. All men aged 19-21, and men 22-26 who have sex with men are also encouraged to get this vaccine.
- Adults >60
- Pneumococcal—this vaccine is covered by Medicare Part B. This vaccine protects against pneumonia infections of the lungs and bloodstream. It is recommended for adults aged 65 and older, and those younger than 65 who have chronic health conditions.
- Zoster—this vaccine is covered by some Medicare Part D plans. The Zoster vaccine protects against shingles, and is recommended for all adults aged 60 and older.
The important thing to remember about Medicare is that all pharmacies bill Part D plans and some can bill Part B, but doctors’ offices can only bill Part B. Be sure to ask your doctor or pharmacist for clarification to make sure you don’t end up paying more for these vaccines than you should!
Written by Karri Dixon, PharmD Candidate
- Vaccine Information for Adults: What Vaccines are Recommended for You. Center for Disease Control and Prevention. http://www.cdc.gov/vaccines/adults/rec-vac/index.html. Assessed June 14, 2015.
- Vaccine Information for Adults: Finding and Paying for Vaccines. Center for Disease Control and Prevention. http://www.cdc.gov/vaccines/adults/find-pay-vaccines.html. Assessed June 14, 2015.