All signs point to the end of summer. County fairs are in full swing. People are in back-to-school mode. And it’s time to start thinking about vaccines ahead of this year’s flu season.

Vaccines play an important role in preventing illness. However, understanding Medicare’s coverage of vaccines can be confusing. Most vaccines that your doctor recommends will be covered by your Medicare prescription drug plan (Part D). Medicare prescription drug plans are required to cover most commercially available vaccines, including Shingles, RSV, and Tdap (Tetanus, Diphtheria, Pertussis/Whooping Cough). Medicare Part B covers vaccines for flu, pneumonia, hepatitis B, and COVID-19. Please talk with your doctor or health care provider about which vaccines are right for you!

Beginning in 2023, Medicare covers all recommended vaccines with no cost-sharing for beneficiaries. There are some important things for you to know related to your Medicare coverage plan. If you have Original Medicare (Parts A & B), you will not pay any out-of-pocket costs for vaccines covered by Part B if your provider accepts assignment. If you have a Medicare Advantage plan, those plans are required to cover Part B vaccines without applying deductions, copayments, or coinsurance if you meet the criteria for coverage and see an in-network provider. For vaccines covered by your Medicare prescription drug plan (Part D), check with your plan for information about how the plan covers vaccines and where you must receive the vaccine.

It remains important, even for your annual vaccinations, to review your Medicare Summary Notice (MSN) or Explanation of Benefits (EOBs) to make sure that claims were submitted appropriately for services that you received. Yes, these statements can be confusing, but it is very important for everyone to review these statements on a regular basis to watch for possible errors or suspected fraud. If you see something that doesn’t look right, contact your provider to ask for additional information about the claim submitted, or contact the Senior Medicare Patrol. For more information about your Medicare Summary Notice, visit this link from Medicare.gov.

If you feel that you have been impacted by suspected Medicare-related fraud, please contact the Wisconsin Senior Medicare Patrol for assistance and support. We can be reached in Wisconsin toll-free at (888) 818-2611 or by email, smp-wi@gwaar.org.