Does Wellcare Cover Vaccines?

Vaccines are an important part of preventive care and are especially critical for older adults, as our immune systems weaken with age. Serious complication from things like the flu, pneumonia and shingles become more likely as you grow older, and regular vaccinations can improve your chance of staying healthy. 

Wellcare Medicare Advantage plans cover vaccines such as the flu shot, pneumococcal and hepatitis B vaccines and the various approved types of COVID-19 vaccines, and many Wellcare Medicare plans may cover even more vaccines, often with no copay or deductible required when certain conditions are met.

What Vaccines Does Wellcare Medicare Insurance Pay For?

All Medicare Advantage (Medicare Part C) plans – including Wellcare Medicare plans – are required by law to cover all the same vaccines that are covered by Medicare Part B. This includes vaccinations for:

• Flu – Flu shots are typically covered once per year during flu season
  
  
• Pneumococcal – Coverage is for a one-time vaccine given in two doses, generally one year apart.
  
  
• Hepatitis B – Coverage is for a one-time vaccine given in two to four doses over one to six months for those at medium to high risk, including those with diabetes.
  
  
• COVID-19 – Coverage includes the two-dose vaccine from either Pfizer or Morderna and the single-dose vaccine from Johnson & Johnson. Medicare covers a COVID-19 vaccine booster shot at least six months after completing the two-dose cycle of the Pfizer or Moderna vaccines or at least two months after the Johnon & Johnson vaccine. 

Additional vaccines are covered if you have been exposed to a harmful virus or bacteria. For example, a tetanus shot would be covered if you stepped on a rusty nail, or a rabies shot would be covered if you were bitten by a stray dog. 

If your Wellcare plan includes prescription drug benefits, you may have coverage for some additional vaccines. Some of the vaccines covered by the prescription drug portion of a Wellcare Medicare Advantage plan may include:

• Shingles – Coverage is typically for a one-time vaccine given in two doses over two to six months.
  
  
• Tdap (tetanus, diphtheria and pertussis/whooping cough) – Coverage is often good for one shot if you have never received the vaccine before along with a booster shot every 10 years.

Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage typically cover vaccines that are commercially available, not covered by Medicare Part B and considered “reasonable and necessary” to prevent illness. Check with your Wellcare plan directly for any additional vaccines that may be covered. 

It’s important to note that if you have a Wellcare standalone Medicare Part D plan, your coverage may not include the flu, pneumococcal, Hepatitis B and COVID-19 vaccines, as these are covered by Medicare Advantage plans. Check with your plan for details.  

How Much Does a Vaccine Cost With Wellcare Medicare Plans?

Medicare Part B offers flu, pneumococcal, Hepatitis B and COVID-19 vaccines and boosters at no cost to the beneficiary when the vaccine is administered by a provider who accepts Medicare assignment, which means they agree to accept the Medicare-approved amount as payment in full for the vaccination they provide.

That means the Part B annual deductible does not apply, and the provider is not allowed to charge a copayment or coinsurance. These no-cost vaccines are also protected by the Affordable Care Act (ACA, sometimes called Obamacare). 

Medicare Advantage plans are required to fully cover these vaccines at no cost to the plan member. However, Medicare Advantage plans do maintain some freedom to issue a copay or apply a deductible when the vaccine is administered by an out-of-network provider or administered outside other terms and conditions set forth by the plan.

It’s advised to check with your Wellcare plan directly for any cost information pertaining to covered vaccines. 

Your Wellcare plan may apply a deductible or charge copayments or coinsurance for some vaccines not listed above. Once again, consult your plan’s benefits to be sure. 

How Can I Enroll in a Wellcare Medicare Plan?

Contact a licensed insurance agent who can help you review Medicare Advantage and plans available in your area from Wellcare and other carriers and discuss the vaccine benefits included in each.