The process that Medicare funds vaccines can be complicated because the U.S. Legislature needs to vote in any new services to be paid by Medicare Part B; so because Congress hasn’t had that vote, some vaccines are covered only by Part D Medicare.
After you are 65 and older and are covered by Medicare, some vaccines are paid for by your Part B benefit (two pneumococcal vaccines and your yearly influenza vaccine). Others are only covered by Part D benefit and cannot be provided in your doctor’s office, including Zoster/shingles vaccine, Tdap (tetanus, diphtheria and pertussis vaccine) or tetanus vaccine. You have to get those Part D vaccines at a pharmacy that provides vaccines, such as Intermountain’s Community Pharmacies.
The good news is if you get those Part D covered vaccines while you are 60-64 years old, you can avoid those Medicare hassles. You can get the vaccines in your doctor’s office, and they should be covered by your commercial health insurance.
So, it is best to get up-to-date on all your adult vaccines before your health insurance transitions to Medicare.
4 immunizations you need to get before turning 65:
- Zoster: After we have chickenpox, the virus still lives in our bodies throughout our lives. When our immune system gets older and doesn’t control the virus as well, it can come back as a painful skin disease called “Shingles.” The Zoster Vaccine reminds our immune system how to protect against the virus and can reduce rate of people getting Shingles as they get older.
- Tdap: We need tetanus boosters on a regular basis; so it is good to get one in the 60-64 year old time frame to make sure we have insurance coverage for it. We also need to have a pertussis vaccine one time when we are an adult to protect us and infants and children we know (like our grandkids) from getting Whooping Cough (or the 100-day cough) that can still be fatal for many infants even with modern medical intervention.
- Flu: Seasonal influenza shots are recommended for everyone, regardless of age. Individuals over 65 years old actually have two choices: the regular flu shot, or “high dose.” High-dose (brand name Fluzone High-Dose) vaccine contains four times the amount of antigen (the part of the vaccine that prompts the body to make an antibody) contained in regular flu shots. The additional antigen is intended to create a stronger immune response (more antibodies) in the person getting the vaccine.
- Pneumococcal: Individuals that are at higher risk for pneumococcal disease (those over 65 years of age, or individuals who smoke or have asthma) are encouraged to receive the pneumococcal conjugate vaccine that protects against 23 types of pneumococcal bacteria.
Vaccination is one of the best ways to protect against diseases, limiting discomfort and potential risks not to mention being cheaper and easier than treating the illness itself. Not only does it protect you, but protects loved ones and others around you that are within close contact. See your doctor or health care provider for more information on which vaccinations are recommended for you. You can also see your local Intermountain Community Pharmacy for information. Find locations at or by calling 800-442-4053.