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.
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 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 cover tetanus vaccines, but a Medicare Part D plan does cover tetanus vaccinations. This article will explain everything Medicare beneficiaries need to know about Medicare and vaccine coverage, specifically in regards 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.
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
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
Nausea and vomiting
Body aches or sore joints
Note: Learn more about tetanus vaccines at this resource.
Does Medicare Cover Tetanus Shots?
Original Medicare does not cover tetanus shots. 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, these vaccines are not included under its coverage, even though it 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. Usually, the Tetanus vaccine costs under $200 in the pharmacy. Discount programs such as GoodRx or the Walmart plan can drop the cost to under $50. Health insurance can also help.
Medicare Part D Plans
While Medicare Part D covers vaccines, there may be out-of-pocket costs. Out-of-pocket costs will vary based on the specific Medicare plan, however. This may include a copay or the beneficiary paying the full cost and getting reimbursed for a certain amount. 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.