What It Is
Hepatitis B vaccination shots
What's Covered
Medicare Part B covers this vaccination for people who are judged to be at high or medium risk for contracting hepatitis B, as determined by a doctor and approved by Medicare. People in these risk groups include the following categories of patients:
High risk
Patients with end-stage renal disease (kidney failure)
Some people with hemophilia
Residents in institutions for the mentally retarded
Residents in the same household as someone who carries the hepatitis B virus
Homosexual men
Users of illegal intravenous drugs
Medium risk
Staff in institutions for the mentally retarded
Healthcare professionals who have frequent contact with blood or blood-derived body fluids
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for the hepatitis B vaccination, contact the plan directly.
What Medicare Pays
If the shot is administered in a doctor's office or clinic, Medicare Part B pays 80 percent of the Medicare-approved amount. If the shot is administered in a hospital outpatient department, Medicare Part B pays the full Medicare-approved amount, except for a patient co-payment.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.
