Doesn’t Medicare cover vaccinations? Why did mine cost $200?

Dear Toni: In October, I enrolled in Medicare but not a prescription drug plan. I went to my doctor in April for my annual physical and had to pay $200 for a shingles vaccination. My doctor’s office told me that I needed to be enrolled in a Medicare Part D prescription drug plan for the shingles shot to have a $0 copay. I thought all vaccinations and immunizations are covered at no cost under Medicare.

I applied for a Part D plan after leaving the doctor’s office and was told that I have to wait until the fall enrollment period. — Cameron, Lubbock, Texas

Dear Cameron: Yes, you will have to wait until Medicare’s open enrollment period (Oct. 15-Dec. 7) to apply for a Part D plan or to change from original Medicare to a Medicare Advantage HMO/PPO plan with prescription coverage. The shingles vaccine is included at no cost with a Part D plan.

Your situation underscores why it is important to enroll in a Part D plan when you are first applying for Medicare (when turning 65, or after age 65 and leaving employer group health insurance). Effective Jan. 1, 2023, the Inflation Reduction Act eliminated all out-of-pocket costs for vaccines that the Centers for Disease Control and Prevention recommends for adults, but those on Medicare must be enrolled in a Part D plan to receive no-cost shots.

The 2026 “Medicare & You” handbook, under “Preventive service: Shots (or vaccines),” explains that Medicare Part B covers flu, hepatitis B and pneumococcal vaccines.

Part D plan beneficiaries can receive their shingles vaccine at their pharmacy or doctor’s office. If you have trouble affording the Part D premium, you might qualify for Medicare’s Extra Help program, which helps people with limited income pay premiums and out-of-pocket costs for Part D coverage.

The handbook also says that Medicare Part D “generally covers all other adult immunizations (recommended by the CDC) to protect you from diseases (like shingles, tetanus, diphtheria, and pertussis and respiratory syncytial virus) at no cost to you.”

If your shot isn’t on your plan’s drug list, the handbook advises you to ask for a coverage exception and to talk with your doctor about which vaccines are right for you.

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.