The new year is starting strong with the news that those with Medicare Part D may receive all recommended vaccines without paying a dime. This is needed as some argue that the U.S. healthcare system is instead a “sick-care” system.
For example, some health insurance companies cover cancer treatments while at the same time refusing to cover tobacco cessation treatments and products. Another example is that many health insurance policies fail to cover nutrition counseling when, arguably,
poor diet is at the heart of many medical conditions.
This change to Medicare Part D is the third piece of legislation to have a major impact on vaccine accessibility. The first was the Vaccines For Children program (VFC) which was passed in 1994. VFC ensures that children in low-income families can receive
all recommended vaccines for only a small administration fee. More than 60 percent of the vaccines given to children are paid for by VFC. The second piece of legislation was the Affordable Care Act (ACA) in 2010. The ACA requires private insurance
companies to make many preventive services, including vaccines, free to their beneficiaries.
The improved vaccine coverage under Medicare Part D came as part of the Inflation Reduction Act (IRA) of 2022. The IRA received bipartisan support to address high prescription drug costs for seniors. Up to this point in time, Medicare coverage of vaccines
was confusing and complicated. Influenza, pneumococcal and COVID-19 vaccines were free during doctor office visits. The Hepatitis B vaccine was also free but only for those considered high risk for catching the disease. Medicare only covered 80 percent
of the cost of tetanus and rabies vaccines required to manage injuries like puncture wounds and animal bites. Coverage of other vaccines differed by the plan that the person selected for Medicare Part D. For example, the shingles vaccine (Shingrix)
currently recommended as a two-dose series for everyone over fifty could cost a person covered with Part D more than $400. As of January 1, 2023, all Medicare Part D recipients, nearly 50 million people, can receive their shingles vaccine for free.
This is not to say that Medicare vaccine coverage is now perfect. One out of 10 adults on Medicare does not subscribe to Part D, so they still have to pay for many recommended vaccines. Additionally, it is difficult for doctors’ offices to contract
with all Medicare Part D plans, so many do not. If there is no contract, the patient has to go to a pharmacy to be vaccinated.
The three essential measures keeping us healthy are nutrition, sanitation, and vaccination. The U.S. has improved access to vaccines with three major pieces of legislation over the last 30 years. We are moving the needle in the right direction from "sick
care" to health care. If you have Medicare Part D and are missing any vaccines, it is the right time to get vaccinated.
Vaccine Smarts is written by Sealy Institute for Vaccine Sciences faculty members Drs.
Megan Berman, an associate professor of internal medicine, and
Richard Rupp, a professor of pediatrics
at the University of Texas Medical Branch. For questions about vaccines, email
vaccine.smarts@utmb.edu.