Medicare Corner
Vaccines and Immunizations
If your provider recommends that you get a vaccine, in most cases it will be covered by your Part D plan. Part D plans must include most commercially available vaccines on their formularies, including the vaccine for shingles (herpes zoster). The only exceptions are flu, pneumonia, hepatitis B, and COVID-19 vaccinations, which are covered by Part B. As of January 2023, all Medicare- covered vaccines should be free to you. This means you should not owe any cost-sharing, such as a copayment, coinsurance, or deductible for your covered vaccines.
To avoid billing issues, it is usually best to make sure that your health care provider or pharmacy administering the vaccine will bill your Part D plan. When you get a vaccine at your doctor’s office, ask the provider to call your Part D plan first to find out if your provider can bill your Part D plan directly. Medicare Part D covers most vaccines and immunizations. However, there are certain vaccinations that are always covered by Part B: • Influenza (flu) shots, including both the seasonal flu vaccine and the H1NI (swine flu) vaccine
• Pneumococcal (pneumonia) shots • Hepatitis B shots • COVID-19 vaccine Part B also covers vaccines after you have been exposed to a dangerous virus or disease. For example, Part B will cover a tetanus shot if you step on a rusty nail, or a rabies shot if you are bitten by a dog. Contact PCOA Medicare at (520) 546-2011 for more information.
Read Your Medicare Statements
Medicare statements outline payments made on a beneficiary’s behalf for Medicare covered services. There are two primary types of statements received by Medicare beneficiaries: Medicare Summary Notices (MSNs) and Explanations of Benefits (EOBs). • Beneficiaries enrolled in Original Medicare receive MSNs. • Beneficiaries enrolled in Medicare Advantage (Part C) plans receive EOBs. • Beneficiaries enrolled in Medicare prescription drug (Part D) plans receive EOBs. MSNs and EOBs explain: • What the health care provider billed for • The amount approved by Medicare for payment
• How much Medicare paid • What the beneficiary may be billed for Detect Potential Fraud, Errors, or Abuse • Review yours or your loved ones' Medicare statements as soon as they arrive to ensure all of the services listed were actually received. • Keep a record of medical visits, tests, receipts for services, and equipment received. A My Health Care Tracker, available from your local SMP, can help you keep a record of these services. • Compare your statements to your receipts, records, and My Health Care Tracker. If you notice any mistakes, or have questions, call your provider or plan with your questions. If you still
These projects are supported in part by grant number 90MPPG0022, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy. secure Medicare account to view their most recent MSNs, track claims made on their behalf, and check payment status. Creating a free, secure account with Medicare allows you to review all bills processed within the past 36 months. have questions or need further help, contact your local SMP. • Medicare’s Medicare.gov website allows beneficiaries in Original Medicare to log into (or create) a
Page 10 | August 2023, Never Too Late
Pima Council on Aging
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