Even though it is rare to have tetanus in the United States today, it is still important that we prevent it. The TDaP vaccine is a great way to protect yourself from what can be a severe or even fatal tetanus infection.
So a common question many people have is, “does Medicare cover TDaP Vaccine?” 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 Vaccine?
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 TDaP vaccine.
Original Medicare (Medicare Part A and Part B) does not provide coverage for the TDaP vaccine. Even though Medicare Part B usually provides coverage for tetanus shots if it is medically necessary to treat an injury or illness, Medicare Part B does not provide coverage for booster tetanus shots such as TDaP vaccines.
That is because Original Medicare mainly covers medically necessary services, equipment, and treatment rather than prescription drugs. Prescription drug coverage may be provided by either Medicare Advantage plans or by Medicare Part D.
Part C and Part D Coverage for TDaP Vaccine
However, some Medicare Advantage plans (Medicare Part C) provide coverage for TDaP vaccines. Medicare Advantage plans cover everything Original Medicare covers and some additional benefits. However, coverage and out-of-pocket costs will vary depending on the specifics of your plan.
Medicare Part D plans also provide coverage for TDaP vaccines. 100 percent of both Medicare Part C and Part D plans provide coverage for the medication TDaP vaccines.
TDaP vaccine is listed as a Tier 3 drug in the Medicare drug formulary. Most of the time Tier 3 medications are preferred branded medications. Tier 3 medications are more expensive than Tier 1 and 2 medications.
How Much Do TDaP Vaccines Cost?
On average, TDaP vaccines cost around $70. This price will vary from pharmacy to pharmacy.
What Is A TDaP Vaccine?
A TDaP vaccine is a combination of booster shots used to increase a person’s immune system against three illnesses, mainly tetanus. The other two illnesses are diphtheria and pertussis, also known as whooping cough. It is administered to people from their preteen years up to adulthood.
There are similar vaccines to TDaP such as:
- Diphtheria and tetanus (DT)
- Tetanus and diphtheria (Td)
- Diphtheria, tetanus, and pertussis (DTaP)
Some of these vaccines are administered at different ages than the TDaP vaccine. Infants receive the DTaP vaccine at two months of age and anyone under six years old. These vaccines are not live vaccines.
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 Trulicity?