Does Medicare Cover Vaccines for Seniors?

As a Senior, you are in a higher risk category. Likely, your doctor has already consulted with you about your health, wellness, and risk factors. He or she may have also covered some of the most frequent vaccinations that are recommended for patients who are 65 and older, particularly if you have health conditions that put you at even higher risk. If your doctor hasn’t already brought this up, then you should make it a priority to find out if there are needed vaccinations that will help protect you from some of the most common (and dangerous) diseases. Also, be sure to mention other indicative factors in your life. For example, if you will be spending time with an infant, you should consult with your doctor to find out what risks you may present to the baby, but also if there are other vaccinations that you should consider in your particular case.

Why Are Vaccinations So Important for Seniors?

Vaccinations help prevent disease and keep you healthy. Whether they are vaccinations for children, reinforcement vaccinations for adults, or vaccinations to help protect you from the latest flu virus, these shots are considered a preventative medical service, so in most cases, your Medicare or other insurance plans will cover the cost. But, as with most medical situations, you can’t take anything for granted. Do your research, consult with your doctor or medical provider, learn about the vaccinations that you should have, and also find out how Medicare will work for you in these particular situations.

There are five vaccinations that you should consider getting as an adult. Here’s a quick rundown on each vaccination.

Should You Get the Influenza Vaccine?

The influenza vaccination is probably the most common vaccination for adults. The flu is a contagious respiratory illness that varies in severity every flu season. In general, symptoms include fever, sore throat, body aches, stuffy nose, headaches, vomiting, and fatigue. Complications can include sinus and ear infections but also more severe side effects like pneumonia, inflammation of the heart (myocarditis), muscle (myositis, rhabdomyolysis), or brain (encephalitis). In extreme cases, you may experience multiple organ failure or extreme inflammation (sepsis).

Why is the Influenza Vaccine Important for Seniors?

The flu virus can be life-threatening for Seniors due to weakened immune systems. To complicate the dangers even further, an estimated 86% of adults who are aged 65+ are also diagnosed with a chronic condition that further compromises their immune systems but can also exacerbate the complications related to flu. Approximately 70-90% of all flu-related deaths involve 65+ population. Due to the risk factors, the CDC recommends a flu vaccination for this population, but you should still consult with your doctor about whether it’s the right choice for your situation.

Medicare Part B covers one flu vaccine every year, while Original Medicare covers the flu shot when and if your doctor accepts the Medicare assignment. Studies show that the flu vaccination does save lives. Beyond just the reduced deaths, there are also the improved recovery and prevention rates, including a reduction in overall hospitalizations of flu patients, ICU admissions, and length of stay. Immunity only lasts about 12 months, but each year a different strain may also be more prevalent, so you must get a flu shot every year. After you get the shot, it typically takes about two weeks for the immunity to take effect.

Should You Get the Shingles Vaccine?

Shingles (Herpes Zoster) is the same virus that is responsible for chickenpox, a common childhood condition that presents as a painful skin rash. After childhood chickenpox, the virus never completely goes away. It lives in your nerve endings, and it can reactivate with older adults, with post-herpetic neuralgia appearing as a painful complication. Shingles is less contagious than chickenpox, but the long-term pain lingers.

Why is the Shingles Vaccine Important for Seniors?

Seniors experience a flare-up or reawakening of the Shingles virus because of their compromised immune systems. The older you are when your Shingles triggers, the more severe the side effects like exhaustion, fever, and loss of appetite (which could also lead to malnutrition) dehydration, and further complications. Most Medicare Advantage with prescription coverage and Part D drug plans typically cover the Shingles vaccine, with copay or co-insurance coverage. You should consult with your doctor to find out if the Shingles vaccine is recommended for your personal health and wellness. The CDC recommends the new Shingrix vaccine, as stronger, longer-lasting protection.

Should You Get the Pneumococcal Vaccine?

Pneumococcal disease involves infections in the lungs (pneumonia), sepsis, infections in the bloodstream (bacteremia), and infections of the linings of the brain and spinal cord (meningitis). These life-threatening infections can lead to brain damage, loss of limbs, or even deafness.

Why is the Pneumococcal Vaccine Important for Seniors?

Seniors are at greater risk to the effects of pneumococcal disease due to weakened immune systems, and the side effects can be much worse. Approximately 18,000 adults 65+ in age die of pneumococcal disease every year, so the FDA and CDC recommend this vaccine for all adults 50+. You may be of greater risk if you smoke or have other health problems. As with so many other medical treatments, you should consult with your doctor before getting the pneumococcal vaccination. Medicare B covers this vaccination, and for Original Medicare, your doctor will need to accept Medicare assignment. For Medicare Advantage to cover the pneumococcal vaccine, it typically must be in-network.

Should You Get the Hepatitis B Vaccine?

Hepatitis B or Hep B is a contagious virus that affects the liver. The flu-like symptoms can include fever and nausea that lasts a few weeks. With chronic Hep B, you may not have any symptoms at all, but the virus still causes liver damage or even death. The best way to protect you from Hep B is to get the shots, which stimulate your immune system.

Why is the Hepatitis B Vaccine Important for Seniors?

Older adults are more susceptible to Hep B due to the changes in liver function that come with age. You may be at particularly high risk if you have diabetes, end-stage renal disease (ESRD), and hemophilia. There’s also no current treatment for Hep B, so it can be very dangerous. Medicare Part B insurance covers the Hep B vaccine if your doctor determines that you’re at significant risk of contracting the virus.
As usual, your doctor or health care provider must accept Medicare assignment. You need to consult with your doctor to determine if you should get the Hep B vaccination. The shot is sometimes referred to as a pneumonia vaccine and based on your doctor’s recommendation, you’ll need two shots that are given a year apart. While side effects are possible, the most typical complaint is pain and discomfort at the injection site. You may also want to get tested for immunity to make sure that the vaccination was effective. If our blood test comes back negative, you’ll need to repeat the vaccination series.

Should You Get the Tdap Vaccine?

The Tdap is a booster vaccination that protects against tetanus, diphtheria, and pertussis (whooping cough). This is one of the reinforcement vaccinations for adults who will be spending time around infants. Young parents often ask their parents and other adults to get the Tdap during the critical period when the baby is under six months and most susceptible.

Why is the Tdap Vaccine Important for Seniors?

The Tdap vaccine is recommended for adults 65+ who have never had the vaccination. It protects against whooping cough for adults and seniors, but it also covers you for tetanus (a booster that must be repeated every ten years). The CDC recommends that you get the two-dose version of the Tdap vaccine. Medicare-prescription drug coverage (Part D) typically covers the Tdap vaccination, but other forms of Medicare like Part A and Part B do not cover Tdap since it’s not always considered a necessary preventative measure to 65+ people. Consult with your doctor to find out if you should get the Tdap vaccination, based on your health and your interaction with an infant in your life. Your doctor or medical provider may also be able to offer further input about the vaccination, what it can do for you, and also whether your Medicare or other insurance coverage will cover the Tdap vaccination shots.

Contact Aines, Carter & Associates

At Aines, Carter & Associates, we’ll consult with you and offer a variety of products and services, from life insurance to Medicare. We know that navigating health care and insurance options can be confusing and difficult. Our goal is to answer all your questions and offer all the detail you need to make the best decisions about your health. Call (855) 367-5614 or contact us online and find out more about what Medicare covers, and what other insurance solutions you should consider for your future.