When it comes to vaccines, with the Tdap you get 3 for the price of 1.
It protects people from 3 horrible diseases. They are tetanus, diphtheria and pertussis (also known as the whopping cough).
Though not necessarily common, these 3 diseases can cause some serious problems for those who get them. So, in the case of the Tdap, better to protect yourself than find yourself having to battle any of those 3 illnesses.
So a common question many people have is, “Does Medicare cover Tdap Immunization?” In this article, we answer that question in clear, plain English. You will also find the average costs of Tdap vaccines and other helpful info.
Does Medicare Cover Tdap Immunization?
The short answer is no. In most cases, Medicare will not cover the cost of Tdap vaccines. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your vaccine.
Original Medicare (Medicare Part A and Part B) does not provide coverage for Tdap vaccines. Though Medicare Part B provides coverage for some preventive vaccines such as flu shots and vaccines for Hepatitis B and pneumonia, it does not provide coverage for Tdap vaccines.
However, some Medicare Advantage plans (Medicare Part C) provide coverage for Tdap vaccines. Medicare Advantage plans cover everything Original Medicare covers but usually also offer some additional benefits. However, coverage and out-of-pocket costs will vary depending on the specifics of the plan.
Medicare Part D plans, which are solely for drug coverage, provide coverage for Tdap vaccines. In fact, 100% of Part D plans cover Boostrix, which is the brand name for the Tdap vaccine.
The exact amount you end up paying will depend on where you get the vaccine and who gives it to you. You may get it at a pharmacy and get the shot there. Or, you can go to your doctor’s office and get the vaccine.
Tdap vaccines are registered in Tier 3 of Medicare’s formulary. Tier 3 medications are preferred brand-name drugs. Tier 3 drugs are more expensive when it is compared to Tier 1 and Tier 2 medications.
The copay for Boostrix in a Medicare Part D plan will generally range between $0 and $100.
How Much Does Tdap Vaccines Cost?
If you don’t have insurance, the cost of the Tdap vaccine will still depend on where you get the shot.
The cost will typically run between $30 and $90 in the U.S. It will generally cost more at a doctor’s office. But some people can get it for free at their doctor’s office.
At national pharmacies, the price will run in the $45 – $70 range.
What Is Tdap Vaccine?
Tdap stands for Tetanus, diphtheria, and pertussis (whooping cough). It is a vaccine to protect preteens and adults from the three diseases said above.
Despite tetanus and diphtheria being rare in the United States today, whooping cough remains an illness that spreads around the country.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover appendix surgery?