Medicare Part D prescription drug plans usually cover the Hepatitis A vaccine on their formularies.
You may still have to pay a copayment or coinsurance toward your deductible.
If you receive the Hepatitis A vaccine while you are an inpatient, Part B may pay instead.
Those vulnerable to Hepatitis A infections should receive the vaccine if they haven’t already.
The Hepatitis A vaccine can prevent you from the “A” hepatitis type that causes liver inflammation. Medicare usually covers the vaccine under a Part D prescription drug plan. What you’ll pay for the Hepatitis A vaccine depends on your plan coverage; in 2022, it varies from $0 to $77 according to GoodRx. If you are at risk of getting Hepatitis A and haven’t been vaccinated, talk to your doctor to see if you should get your shot.
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Medicare covers the Hepatitis A vaccine under Medicare Part D (prescription drug coverage) for most people who receive the vaccine at a doctor’s office or other outpatient facilities. Medicare requires all Part D plans to cover the Hepatitis A vaccine.
What you pay for the Hepatitis A vaccine depends upon your drug plan, your deductible and if you have any other coverage such as Medicaid or Extra Help to pay for medications.
Part D plans will list their covered medications on a list called a formulary. The medications are on different levels called tiers. Higher-tiered medications are more expensive compared to those on lower tiers.
While Part D generally covers the Hepatitis Part A vaccine, Parts A or B may pay a portion depending on where you get the shot. If you were to receive the Hepatitis A vaccine while in the hospital or a skilled nursing facility (inpatient), Medicare Part A may pay for the shot to be administered. If you receive the shot at your doctor’s office (outpatient), Part B may be involved.
Hepatitis A is transmitted via a fecal-oral route. Some of the common ways a person can get Hepatitis A include:
- Consuming contaminated food and water.
- Having close contact with an infected person.
- Having sexual contact with a person with an active Hepatitis A infection.
While a person can’t always identify who may have an active Hepatitis A infection, they can practice good hygiene. Examples include washing hands after going to the bathroom, washing hands after changing diapers and always washing hands before and after eating. These methods can ideally help prevent a Hepatitis A infection.
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Multiple forms of hepatitis exist, and the major types are named by letter: A, B, and C. Medicare Part D covers the Hepatitis A vaccine in most cases. However, you’ll likely pay to receive the vaccine as you would pay for prescription medication. This often means paying a copay.
However (and confusingly), Medicare Part B covers the vaccine against Hepatitis B for people that meet Medicare’s guidelines. If a person meets the criteria as a medium- to high-risk for Hepatitis B, they won’t pay anything for receiving the vaccine as long as they get it from a provider who accepts Medicare.
You may still get a bill for your Hepatitis A vaccine from Medicare Part B, which is medical coverage under Medicare. This bill is not for the vaccine contents itself, but for the vaccine’s administration. Your provider’s time and supplies (such as the syringe) are taken into account.
Yes, Medicare pays for both Hepatitis A and B vaccines. Medicare usually pays for the Hepatitis A vaccine under Part D and pays for the Hepatitis B vaccine under Part B. If you receive a Hepatitis A vaccine under Part D, you may have to pay a copayment.
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Doctors do not know exactly how long the Hepatitis A vaccine coverage lasts. According to the Centers for Disease Control and Prevention (CDC), there is some data to support that a person still has antibodies against Hepatitis A 20 years after receiving the Hepatitis A vaccine.
How often should Hep A vaccine be given?
Doctors commonly give the Hepatitis A vaccine to children and may encourage others to receive it if they have certain diagnoses, living conditions or other factors that put them at higher risks for Hepatitis A. While Hepatitis A is usually a mild virus in a very healthy person, the risk is much higher for others. For example, Hepatitis A can be severe for people who are older and immunocompromised. Because Medicare provides insurance for those aged 65 and older and those with chronic illnesses and disabilities, it can benefit these populations by offering Hepatitis A vaccination (if they haven’t gotten the vaccine already).
You’re more at risk for Hepatitis A if you fall into any of these categories:
- You travel to countries with higher rates of Hepatitis A.
- You are homeless.
- You use illegal injection drugs.
- You are a worker who is at higher risk for occupational exposure (such as a healthcare worker).
- You have been exposed to a Hepatitis A outbreak within the last two weeks.
There are less-definitive recommendations for the Hepatitis A vaccine if you have already had a dose at some point in your lifetime. Your doctor may first recommend having blood drawn to test if you have antibodies (immune system cells that fight diseases) to Hepatitis A. The presence of antibodies means you are protected against severe forms of the disease. Your doctor can help guide you if you should need the shot again based on your risk factors and overall health.