Medicare and Immunizations Pearls

  • Current for today
    • Medicare will cover Pneumovax and Prevnar once in a person’s lifetime after age 65 unless they are high risk and then they can have a booster every 5 years. I’ve found, even though they don’t publish it, that if a patient has Medicare before age 65, they are still covering it for younger ages.
    • Tdap is only ever covered if the patient has an acute laceration. Boosters are never covered.
    • Zostavax is never covered in the office. The patient can go to the pharmacy and have them bill their Part D insurance, but the Part B insurance that we bill as a doctor’s office does not cover Zostavax.
    • Hep B is covered for those at high or intermediate risk, like w/ renal disease, hemophilia, homosexual men and clients of institutions, but not as a preventive measure outside those parameters.
    • Medicare never covers MMR, Varicella, or Hep A.
    • These parameters follow the patient and not the office, so we might not have the history available to us to know if it will be covered and so my advice is to ALWAYS get an ABN.

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