Does Medicaid Cover Tetanus Shots?
- The CDC recommends a tetanus vaccine for adults and kids of all ages. Learn whether Medicaid covers this shot and how you can reduce your out-of-pocket cost.
Tetanus, which is sometimes referred to as lockjaw, is a bacteria-caused illness that results in painful muscle contractions. The tetanus vaccine, which is given in combination with the pertussis and/or diphtheria vaccines, offers nearly complete protection against the disease for a period of about 10 years, and it's recommended by the CDC for children and adults of all ages. If you’re a Medicaid enrollee who's wondering whether Medicaid covers tetanus shots, the answer depends on your state of residence.
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Does Medicaid Cover Tetanus Shots?
Because Medicaid is jointly funded by state and federal governments, the program specifics vary significantly by state. Although the Medicaid programs in most states cover some adult immunizations, not every state offers coverage of all the vaccines recommended by the Advisory Committee on Immunization Practices, including the one for tetanus. The best way to find out if your Medicaid program covers tetanus vaccines is to contact your local Medicaid agency directly.
The Vaccines for Children Program
The VFC program provides immunizations to kids under 18 who are uninsured, underinsured or enrolled in Medicaid and children who identify as American Indian or Alaska Native. Because vaccines are supplied to providers by the federal government, the serum is available at no cost. If the child is a Medicaid enrollee, Medicaid pays the vaccine administration fee. Parents of children who aren’t enrolled in Medicaid may be billed an administration fee, which varies by state.
The Early and Periodic Screening, Diagnostic and Treatment Benefit
EPSDT was designed to make sure low-income children and adolescents have access to essential preventive services and dental, mental health and specialty care. Through this program, children under the age of 21 receive vaccines recommended by the Advisory Committee on Immunization Practices, such as DTaP, Tdap and Td, free of charge.
Is There More Than One Type of Tetanus Shot?
There are four types of tetanus shots, all of which include protection against additional diseases such as pertussis and diphtheria:
- DTaP: The DTaP vaccine is typically given as a base shot to immunize an individual against tetanus, diphtheria and pertussis. The vaccine is given as a five-shot sequence, which is administered to children at ages 2, 4 and 6 months and then again at 15 to 18 months and 4 to 6 years.
- Tdap: If you didn’t receive a tetanus vaccine as a child, you’ll probably be given the Tdap vaccine because it’s less likely to cause side effects in adolescents and adults due to its content, which includes lesser quantities of diphtheria and pertussis proteins.
- DT: The DT vaccine is typically administered to children under the age of 7 who shouldn’t receive the pertussis proteins for medical reasons, such as an allergic reaction.
- Td: Commonly used as a tetanus booster, particularly after the occurrence of a wound, the Td vaccine contains less diphtheria protein, so it has fewer side effects when given to adults.
Are Tetanus Vaccines Free?
Although tetanus vaccines aren’t generally free, you may receive one at no cost if your health insurance covers it. Under the Affordable Care Act, any plan purchased through Healthcare.gov or a state-run marketplace must offer certain common preventative services, including tetanus shots for recommended populations, without charging recipients a copayment or coinsurance. To find out if this applies to you, check with your insurance company or review the contractual terms of your individual plan.
How Much Does a Tetanus Shot Cost Out of Pocket?
If you don’t have medical insurance and you’re paying for a tetanus shot out of pocket, your cost will likely depend on several factors:
- Which vaccine you receive (DT, TD, Tdap or DTaP)
- The manufacturer
- Where it’s administered
- Your region of residence
For example, if you’re receiving a Td booster and paying out of pocket, it'll typically cost between $25 and $60, which includes the cost of the serum and the administration fee. If you’re receiving a TDaP shot, you’ll probably pay more.
When Do You Need a Tetanus Shot?
The CDC recommends that all adults receive a Tdap shot, which includes the vaccine for tetanus, diphtheria and pertussis, which is also known as whooping cough. The shot may be given at any time and should be followed up by a Td to Tdap booster every 10 years.
Because the bacteria that causes tetanus can infiltrate the human body through a wound such as a cut, scrape or burn, you should also consider getting a tetanus shot if you’ve been injured, especially if your wound was caused by a dirty object or an animal bite and you haven’t received a tetanus booster within five years. If the wound is clean, and you’ve had a tetanus shot within 10 years, you may not need additional protection. When seeking a tetanus vaccine in response to an injury, you should get the shot within 72 hours of the event.
If you’re not sure whether you should get a vaccine after an injury, your primary care physician or an urgent care clinic can recommend the best course of action.
Can You Get Help Paying for a Tetanus Shot?
If your state Medicaid agency doesn’t pay for a tetanus shot and you aren’t covered by other insurance, you may be able to get help paying for the vaccine through manufacturers’ beneficiary assistance programs. Financial assistance for tetanus vaccines are available through:
- GSK Vaccines Access program. GlaxoSmithKline offers financial assistance to uninsured and low-income individuals who need the Tdap vaccine. Applications must be submitted by a healthcare provider and should include a valid prescription for the vaccine and proof of the applicant’s household income.
- Sanofi Patient Assistance Connection: Sanofi offers financial assistance for their Tdap vaccine to individuals who are uninsured or have medical insurance that doesn’t cover the vaccine. Applicants must meet the program’s financial guidelines, and the application must contain a doctor’s signature.
County health departments and low-cost public clinics may offer additional options for individuals who can’t afford to pay out of pocket for a tetanus vaccine or other preventative health services. Visit the public clinic locator to search for a location by ZIP code.