Vaccine coverage

How does Prevea360 Medicare Advantage cover vaccinations?

Prevea360 Medicare Advantage lists covered vaccines in our formulary. A new preventive vaccine may not specifically appear in the formulary, but Prevea360 Medicare Advantage may still cover the vaccine.

Medicare Part B covers preventative vaccines in the doctor office such as:

Influenza: you need yearly.
Pneumococcal: you need once per lifetime but a high-risk booster every five years.
Hepatitis B: you need if you are considered middle to be high risk.
Other vaccines that are covered in your doctor's office and meet Medicare guidelines.

Your pharmacy can administer other vaccines with a $0 dollar copay. Some of these vaccines include Shingles and tetanus, diphtheria and acellular pertussis (Tdap). Our plan covers these at an In-network pharmacy where pharmacist are certified to administer.

See your formulary for all covered vaccines.

Contact our Member Services at 1-877-232-7566 (TTY: 711) to find out about coverage.

Medicare Part B provides preventive coverage for certain vaccines, which includes:

Influenza: once per flu season.
Pneumococcal: once per lifetime with high-risk booster after five years.
Hepatitis B: for persons at intermediate- to high-risk.
Other immunizations are covered under Medicare Part B only for those who meet coverage rules and are at high-risk.

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Medicare Part D: See your formulary for a full list of covered Part D vaccines.

These $0 vaccines are listed in our formulary as tier 6. Cost-sharing will apply when you are in the catastrophic stage. To obtain the best benefit under your Part D plan, receive your vaccine from a network pharmacy that employs pharmacists certified to administer vaccines. Search our pharmacy directory to find network pharmacies in your area or contact Member Services at 1-877-232-7566 (TTY: 711). Receiving your Part D vaccines in a physician’s office may mean you are financially responsible for the cost of the services and will need to submit insurance claims on your own.

Learn more about the benefits of vaccines and immunization from the Centers for Disease Control and Prevention (CDC):

Vaccines and Immunizations: The Basics

Questions?

Members: speak with member services at 1-877-232-7566 (TTY: 711)

Not a member? Talk with a sales representative at 1-877-234-0126 (TTY: 711), including for alternate formats and languages.

Mailing Address:

Prevea360 Medicare Advantage
PO Box 56099
Madison, WI 53705