Medicare Coverage of the Hepatitis B Vaccination

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.

Stay Connected With

Get news & tips via e-mail