Most Adult Vaccinations Are Free. So What’s Your Excuse?

Health Writer

By the time they start kindergarten, well over 90 percent of kids are up to date on their vaccines—because schools won’t let them in if they’re not. But nobody is pestering their parents and grandparents, and adult vaccination rates show it.

A new report just out from the Advisory Committee on Immunization Practices (ACIP), the national panel of experts that decides which shots Americans need, tells the tale. Only 20 percent of adults are current on their tetanus-diphtheria-whooping cough boosters. Fifty-seven percent don’t get their annual flu shot. At age 60 people should get a shingles shot to protect them against the misery of that illness, but only 28 percent have done so.

Roughly 10 percent of Americans don’t have health insurance and may not be able to afford the shots. But there’s no excuse for the other 90 percent, because the shots (in all but a small percentage of cases) will cost them nothing.

That’s because private health insurers and Medicare, under the Affordable Care Act (aka Obamacare), must cover the vaccines that ACIP recommends—for free, with no deductibles or copays. The only exceptions are a small number of “grandfathered” plans that existed before the ACA and have been allowed to remain in force. In the case of Medicare, a few shots are covered under Part B and the rest under Part D.

If you look at the ACIP’s complete adult schedule, you’ll see that several of the vaccinations are only for people with specific risk factors. But others are recommended for everyone within specific age ranges (except for those who are immunocompromised or have allergies to vaccine ingredients). Here’s a checklist of what to get:

Influenza. Everyone over the age of 6 months needs a flu shot every year. If 65 or over, ask for the high-dose version. Medicare Part B covers this in full.

• MMR (measles-mumps-rubella) and chickenpox. Unless they were vaccinated or had the diseases as children, adults of any age should get the chickenpox shot and adults under age 60 need the MMR vaccine. The chickenpox vaccine is available through Medicare Part D.

Pneumonia. ACIP recommends two pneumococcal vaccines for everyone 65 and up. Get PCV13 to start, and PPSV23 the following year. Medicare Part B covers both.

• Td/Tdap. The letters stand for tetanus, diphtheria, and whooping cough (acellular pertussis), typically administered together. Adults need one Tdap shot and then a Td booster every 10 years. Medicare Part D covers this vaccine.

• Shingles (zoster). Recommended for everyone age 60 and older (even if they already had shingles). The shingles vaccine is not covered by Medicare Part B, but by Medicare Part D (which you have to pay for separately and covers prescription drugs) or Medicare Advantage plans, though you’ll probably have to pay a copay or part of your deductible. Your best bet to reduce the cost is to get the vaccine at a pharmacy in your drug plan’s network, but you’ll first need a prescription from your doctor. Here are other strategies on how to save on the cost of this shot.

E-mail us with your Medicare or health insurance questions.