Happy August Brokers!
AEP is fast approaching, and we are here to help you prepare! Considering this month’s focus on Immunization Awareness, we want to ensure you’re well-prepared with the most up-to-date coverage information when meeting with your clients this upcoming AEP season.
Knowing what immunizations are covered under their Medicare plans, will help you better assist your clients. It’s important that seniors stay up to date with vaccinations as they can play an important role in preventive care. Fortunately, Medicare Part B and D plans offer comprehensive coverage for a range of vaccines, ensuring that older adults can access the protection they need to lead healthier, active lives.
As some of you may be aware of, the recently passed Inflation Reduction Act Lowers Health Care Costs for Millions of Americans. This legislation brings substantial benefits to millions of Americans throughout the country, including all 50 states, the United States territories, and the District of Columbia. Some of the key advantages are reduced Prescription Drug prices in Medicare, yearly cap on out-of-pocket Prescription Drug Costs in Medicare, and continued lower health insurance premiums.
Immunization Coverage under Medicare Part B:
- Influenza (Flu) Vaccine: Medicare Part B covers the annual flu shot, protecting seniors from seasonal flu and its potential complications.
- Pneumococcal Vaccines: Your clients will be glad to hear about coverage for two types of pneumococcal vaccines – PCV13 and PPSV23. These vaccines give a good defense against pneumonia, meningitis, and those pesky bloodstream infections caused by Streptococcus pneumoniae.
- Hepatitis B Vaccine: For seniors at risk of hepatitis B, Medicare Part B offers coverage for the hepatitis B vaccine, preventing liver infections caused by the virus.
- Covid-19: Approximately $40 for single-dose vaccines
- For vaccines requiring multiple doses, approximately $40 for each dose in the series, including any additional doses and booster doses.
Current Covered Immunizations under Medicare Part D:
Your beneficiaries with Medicare Part D drug coverage now pay nothing out-of-pocket for even more vaccines. Part D plan won’t charge a copayment or apply a deductible for vaccines that the Advisory Committee on Immunization Practices recommends. * Per CMS Guidelines; Even if a drug plan’s formulary does not list all Part D vaccines, it must provide access when a physician prescribes a Part D vaccine to prevent a patient’s illness. *
Treatment vs. Prevention
CMS Medicare Part D Vaccines MLN Fact Sheet – June 2023
For example, if a patient gets a tetanus vaccination because of an accidental puncture wound, it’s a Part B-covered vaccine. However, if you patient gets a tetanus booster shot, unrelated to injury or illness, it’s a Part D-covered vaccine.
Drug plans cover vaccine administration costs, such as Dispensing fee (if applicable), Sales tax (if applicable), Vaccine administration fee, Vaccine ingredient cost.
Some of the common covered Vaccines include:
- Shingles Vaccine: The shingles vaccine helps prevent the painful and debilitating rash caused by the varicella-zoster virus, which remains dormant in the body after a person has had chickenpox.
- Tdap and Td Vaccines: These vaccines protect against tetanus, diphtheria, and pertussis (whooping cough).
Some things to remember when reviewing your beneficiary’s plan:
Schedule a coverage plan review with your clients this AEP season. It’s a good idea to review their specific Part B and D plan details and go over any new health issues they may have acquired over the year to make sure they are receiving the necessary coverage, and have a clear understanding of the immunizations covered that may help with preventative care.
Encourage your client to visit in-network pharmacies to make sure everything’s covered under their Medicare Part D. Out-of-network pharmacies may result in additional costs.
As you plan for the AEP season and prepare to meet with your clients, remember to share this valuable information so they continue to feel empowered with up-to-date knowledge on their plan coverage and preventative care. If you’d like to learn more about covered immunizations, please visit CMS.gov, or you may also contact our client support services at 844-998-7878.