What to Know About Medicare and Coverage for Tetanus Shots
Article at a glance
- Vaccinations are an important part of both public and individual health. Vaccinations often require booster shots in order to remain effective and prevent illness.
- The Centers for Disease Control and Prevention (CDC) recommends tetanus shots for young children, preteens, and adults. Adults should receive a tetanus booster shot once every 10 years.
- While Original Medicare does not cover tetanus vaccines, Medicare Part D ( prescription drug coverage), covers all commercially available shots, including the tetanus shot and the RSV vaccine.
Vaccinations are a vital component of keeping both individuals and communities safe and healthy. Medicare covers some vaccines. These include the flu shot, hepatitis B shot, pneumococcal shots, and COVID-19 vaccines.
There are a variety of vaccines the Centers for Disease Control and Prevention (CDC) encourage children and adults to receive throughout their lifetime. One of these vaccinations is the tetanus shot, also known as the Tdap vaccine.
The CDC recommends tetanus vaccinations for young children, preteens, and adults. The CDC states that children receive their tetanus shot in three doses spread out between 6 weeks and 4 years of age, preteens receive one dose between 11 and 12 years old, and adults should get a tetanus booster shot every 10 years. In the event a Medicare beneficiary is due for a tetanus booster shot, they may be wondering whether Medicare covers the Tdap vaccine.
In short, Original Medicare does not usually cover tetanus vaccines, but according to Medicare.gov, “(Part D) covers all vaccines that the Advisory Committee on Immunization Practices (ACIP) recommends, including the vaccines for Tdap, Respiratory Syncytial Virus (RSV), shingles, and more.” In some cases, Medicare Part B does cover the tetanus vaccine if the beneficiary was directly exposed to the disease. This article will explain everything Medicare beneficiaries need to know about vaccines covered by Medicare, with specific information related to tetanus shots.
What is Tetanus?
Tetanus is an infection caused by Clostridium tetani, a common type of bacteria. When this bacteria invades the body, it produces a toxin that causes painful muscle contractions. Tetanus is also referred to as “lockjaw” because it often triggers a person’s neck and jaw muscles to lock, making swallowing and opening the mouth difficult. Severe complications from untreated tetanus can include broken bones due to intense muscle spasms, breathing problems, high blood pressure, and death.
Tetanus is deadly in the absence of the vaccine. Besides the vaccine, there is no cure.
Someone can contract tetanus in various ways, including:
- A wound becoming contaminated with dirt, feces, or saliva
- Puncture wounds, such as from a rusty nail
- Burns
- Crush injuries
- Insect bites
- Dental infections
What is the Tetanus Vaccine?
The tetanus vaccine, also known as the Tdap vaccine, prevents tetanus, diphtheria, and pertussis
(whooping cough). According to the CDC, there are currently four types of vaccines available to prevent tetanus and other diseases:
Diphtheria and tetanus (DT) vaccines
Diphtheria, tetanus, and pertussis (DTaP) vaccines
Tetanus and diphtheria (Td) vaccines
Tetanus, diphtheria, and pertussis (Tdap) vaccines
The DTaP and DT vaccine is recommended for young children. Older children and adults are recommended to receive the Td or Tdap vaccinations. In older children and adults, the Tdap vaccination is administered in the upper arm.
Potential side effects after getting the tetanus shot may include:
Pain, redness, and swelling where the vaccine was given
Fever
Headache
Tiredness
Nausea and vomiting
Chills
Body aches or sore joints
Rash
Swollen glands
Note: Learn more about tetanus vaccines at this resource.
Does Medicare Cover Tetanus Shots?
Original Medicare does not cover tetanus shots unless someone is directly exposed to the disease. As a reminder, Medicare Part A is Medicare’s hospital insurance and Medicare Part B is Medicare’s medical insurance. While Medicare Part B covers preventive services, few vaccines are included under its coverage, even though the vaccine does prevent tetanus.
That said, Medicare coverage for prescription drugs, known as Medicare Part D, covers all commercially available vaccines needed to prevent illness, including the tetanus shot and shingles vaccine.
Do Medicare Advantage Plans Cover Tetanus Shots?
Medicare Advantage plans are Medicare plans offered by private insurance companies that are Medicare-approved. A Medicare Advantage plan, also known as Medicare Part C or an MA plan, will provide, at minimum, standard Medicare coverage. Many Medicare Part C plans also offer additional health benefits, including vision, dental, hearing, and more.
Medicare beneficiaries interested in a Medicare Advantage plan should always confirm extra perks with their insurance company. That said, most Medicare Advantage plans include Part D coverage within their health plans. Therefore, it is likely the tetanus shot will be covered.
What Are The Tetanus Vaccination Costs?
The tetanus vaccination may come with out-of-pocket costs. According to the CDC vaccine price list, the tetanus shot is usually $42–49 per dose, depending on the drug manufacturer. Discount programs such as GoodRx or the Walmart plan can drop the cost to under $50 and help beneficiaries receive more cost coverage for tetanus shots. Health insurance can also help.
Medicare Part D Plans
While Medicare Part D covers vaccines, there may be out-of-pocket costs. Luckily, the recent inflation reduction act has made the tetanus shot free of charge to people with Medicare Part D coverage. Eligible individuals should receive the Tdap shot at a doctor’s office within the drug plan’s network or at an in-network pharmacy.
Private Health Insurance Plans
When it comes to private health insurance plans, most of these health plans will cover the tetanus vaccination. Again, this will vary based on the specific health care plan. Those with a private health care plan should contact their plan provider for confirmation.
Medicaid
Medicaid services are required to fully cover any vaccines recommended by the Advisory Committee on Immunization Practice. Currently, the committee recommends the tetanus vaccine against this infection caused by clostridium tetani throughout someone’s life.
FAQ
Should seniors get a tetanus shot?
Yes, the CDC recommends that all adults should get a Tdap (tetanus, diphtheria, and pertussis) shot every 10 years. Someone may also be recommended a Tdap vaccine between the 10 year shots if they were exposed to something that puts them at medium or high risk to one of the three conditions.
Does Medicare cover the Tdap shot?
No, Original Medicare plans do not include coverage for vaccinations such as the Tdap vaccine. While Medicare Part B covers preventive services, vaccinations are not included in those services. If a beneficiary wants or needs coverage for vaccines, they need to get a Medicare Advantage plan, a Medigap plan of some sort, or separate policy for Medicare Part D. Medicare Part D covers several vaccines recommended for older adults, as well as prescription medications for severe illnesses, viral infections, and chronic conditions.
What vaccines are covered by Medicare?
Medicare Part B covers the hepatitis b vaccine, an influenza vaccine each flu season, COVID-19 vaccines, and pneumococcal vaccines. If someone has high risk factors or is exposed to a disease or condition, Part B may also cover any relevant adult vaccines the doctor recommends. Several vaccines are also covered by the optional Medicare Part D, including RSV and the shingles vaccine. These vaccines typically aren't always fully covered, meaning there may be a cost sharing model where Medicare pays some, and the beneficiary pays a small amount. This applies whether a vaccine has two doses or one shot, is annually or a one-time vaccine.
