Medicare Vaccination Coverage After the Inflation Reduction Act: Action Still Needed to Enable High Vaccination Rates Among Medicare Beneficiaries

Medicare’s coverage of vaccinations recommended for adults is split between its Part B medical benefits and Part D prescription drug benefits, although coverage of vaccinations for two highly-prevalent infectious respiratory diseases, influenza, and COVID-19, are both covered under Part B medical benefits. The split in coverage is ripe for reassessment. For example, Medicare coverage of new and oncoming vaccinations for respiratory syncytial virus (RSV) will default into Part D coverage, which will reduce opportunities to promote, administer and reimbursement vaccinations for infectious respiratory disease on a unified basis. Other factors, including increasing enrollments in Medicare Advantage-Prescription Drug Plans, also compel a new look at how Medicare’s coverage of all recommended vaccinations could be more effective.

NEHI brought together key stakeholders in late 2022 and early 2023 to assess Medicare vaccination coverage.  “Medicare Vaccination Coverage After the Inflation Reduction Act” summarizes the findings of NEHI staff on the future of Medicare vaccination policy.