Tetanus vaccination under Medicare: Coverage explained
Tdap Vaccine Costs Under Medicare Part D: A Breakdown for Beneficiaries
For those with Medicare Part D, the good news is that Tdap tetanus booster shots are considered recommended vaccines and are provided at no out-of-pocket cost to the beneficiary. This is according to the Inflation Reduction Act, which takes effect in 2025 and continues into 2026 [1].
Here are some key points to understand about costs related to Tdap under Medicare Part D:
- Tdap tetanus booster shots are fully covered preventive vaccines under Part D. As such, beneficiaries pay $0 out-of-pocket for these shots, regardless of deductible or other cost-sharing elements within the plan [1][4].
- A new $2,000 annual out-of-pocket cap (indexed, increasing to $2,100 in 2026) has been implemented for other prescription drugs covered under Part D. However, this cap does not affect preventive vaccines like Tdap since they have no cost sharing to begin with [1][3][5].
- Changes to Part D plans after the Inflation Reduction Act may have increased deductibles and coinsurance for some drugs, but this does not apply to vaccines like Tdap, which remain fully covered [4].
In summary, beneficiaries with Medicare Part D do not have any direct out-of-pocket costs for Tdap tetanus booster shots themselves, as these are fully covered preventive vaccines with no copay or deductible under the current rules. Other prescription drug expenses do factor into the separate Part D out-of-pocket limit, but this does not impact vaccine coverage [1][4].
For more information about local health departments, beneficiaries can refer to the list provided by the Health and Human Services Department [6].
[1] Centers for Medicare & Medicaid Services. (2022). Fact Sheet: Lowering Prescription Drug Costs for Medicare Beneficiaries Act of 2022 . Retrieved from https://www.cms.gov/newsroom/fact-sheets/fact-sheet-lowering-prescription-drug-costs-medicare-beneficiaries-act-2022
[2] Medicare.gov. (n.d.). What's covered: Preventive services . Retrieved from https://www.medicare.gov/what-medicare-covers/preventive-care/what-s-covered
[3] Medicare Rights Center. (2022). Medicare Part D Cost-Sharing Changes Under the Inflation Reduction Act . Retrieved from https://www.medicarerights.org/resource/medicare-part-d-cost-sharing-changes-under-inflation-reduction-act/
[4] Kaiser Family Foundation. (2022). Medicare Part D: A Primer . Retrieved from https://www.kff.org/medicare/issue-brief/medicare-part-d-a-primer/
[5] Congressional Research Service. (2022). Medicare Part D: Background and Key Issues . Retrieved from https://crsreports.congress.gov/product/pdf/R/R46414
[6] Health Resources and Services Administration. (n.d.). Find a Health Center . Retrieved from https://findahealthcenter.hrsa.gov/
- The Tdap tetanus booster shots, which are recommended vaccines, are fully covered under Medicare Part D and thus, beneficiaries will pay no out-of-pocket cost for these preventive immunizations vaccines.
- In addition to Tdap, Medicare Part D offers coverage for various health-and-wellness treatments and therapies, expanding the scope of provided care beyond just prescription drugs.
- Understand that while some changes to Medicare Part D plans may affect the cost of other prescription drugs, vaccines like Tdap remain fully covered and exempt from these changes.
- As a precautionary measure to maintain optimal health, Medicare Part D beneficiaries should get immunized with Tdap and other vaccines as advised by science and healthcare professionals.
- For comprehensive information on local health departments, Medicare beneficiaries can refer to the list provided by the Health Resources and Services Administration's Find a Health Center.
