Medicare Hepatitis B Vaccine Shot Coverage
Key Takeaways
- Hepatitis B is highly contagious.
- To help prevent Hepatitis B, you can receive a vaccine given as a three-shot series over six months.
- Medicare Part B pays the full cost of the Hep B vaccine if you are at medium to high risk for this condition.
- If your risk is low, Medicare Part B will not pay for the Hep B vaccine.
- If you have Medicare Part C and are eligible for the Hepatitis B vaccine, your plan will pay for it.
Hepatitis B is a highly contagious liver infection caused by the Hepatitis B Virus (HBV). Complications from Hep B include liver cancer, liver failure and, occasionally, death. Luckily, this condition can be prevented by a vaccine.
Anyone can get Hepatitis B, but certain people have jobs, behaviors or medical conditions that put them at greater risk.
If you have Medicare, you may be wondering if you have coverage for the Hepatitis B vaccine. Read on to find out what circumstances prompt Medicare to cover the Hep B shot.
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Is the Hepatitis B Vaccine Covered by Medicare Part B?
Medicare Part B is your medical coverage with Original Medicare. It covers outpatient services, including preventive care and some vaccines. For some beneficiaries, Part B may include the cost of the Hepatitis B vaccine.
If your risk for Hepatitis B is medium to high, Medicare Part B will cover the cost of the Hepatitis B vaccine. Medicare Part B won’t pay the price of this vaccine for people who are at low risk.
You are classified as high risk if you have certain medical conditions or come into contact with blood or bodily fluids regularly.
The Hepatitis B vaccine is a series of three shots over a six-month timeframe. You must get all three injections, or you remain at risk of contracting Hep B.
Does Medicare Pay for Hepatitis A and B Vaccines?
Original Medicare doesn’t pay for the Hepatitis A vaccine. However, if you have Medicare Part D (prescription drug) coverage, your plan will pay all or some of the cost of this vaccine. Every Part D drug formulary covers the Hep A vaccine.
If you have a Medicare Advantage (Part C) plan that includes drug coverage, it will also pay for the Hepatitis A vaccine.
Medicare Part B pays for the Hepatitis B vaccine. Medicare Part C covers at least as much as Original Medicare. If you have a Part C plan, it will cover the cost of the Hepatitis B vaccine.
The Twinrix vaccine protects against Hepatitis A and Hepatitis B. Your Medicare Part D plan will cover this vaccine.
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How Much Does Hep B Vaccination Cost?
If your doctor, pharmacist, or health care provider is Medicare-approved and accepts assignment, you will pay nothing for the Hep B shot. To get coverage from Medicare, you must be eligible to receive it.
You may incur charges such as a copay for your doctor’s visit if you see your provider for other services, such as an exam or blood test, during the same appointment.
If you don’t have Medicare or aren’t eligible to receive coverage for the Hepatitis B vaccine, your costs may range between $120 – $340 or more for all three shots in the vaccine series.
How Long Does the Hep B Vaccine Last?
If you complete the entire three-shot Hep B vaccine series, you can expect to have immunity for at least 10 years. Some data indicate that immunity from the vaccine lasts longer, for 32 years or more.
Your risk level will determine whether you require a Hep B booster sometime in the future.
Who Needs the Hep B Vaccine?
Hepatitis B is highly contagious. You may be at medium to high risk if:
- You’re a healthcare worker.
- You share drug-injection equipment such as needles and syringes with other people.
- You’re a sex worker of any gender or have multiple sexual partners.
- You have chronic kidney disease (end-stage renal disease).
- You have liver disease.
- You have hemophilia.
- You have diabetes and are over 60 years old.
- You live with someone who has Hep B.
- You’re traveling to a country or location where HBV infection is prevalent.
There are several manufacturers of Hepatitis B vaccines. Each vaccine contains an antigen, or active ingredient, which stimulates the immune system to protect from HBV.
The inactive ingredients in each vaccine may vary. They include:
- Aluminum hydroxide
- Yeast protein
- Sodium chloride
- Disodium phosphate dihydrate
- Formaldehyde
- Potassium aluminum sulfate
- Polysorbate 80
Vaccine reactions can occur as the result of any vaccine, including the Hepatitis B vaccine. Some side effects you may experience include:
- Soreness, redness or swelling at the injection site
- Fever
- Headache
- Fatigue