Does Medicare Cover Tetanus Shots?
- Doctors may recommend tetanus shots for seniors with animal bites and other wounds, but does Medicare cover tetanus shots? Learn which plans cover this vaccine.
If you step on a rusty nail or get bitten by an animal, your doctor may recommend a tetanus shot. This vaccination is intended to protect you from this painful bacterial infection, which can cause debilitating muscle contractions. Does Medicare cover tetanus shots if you're 65 or over and need one? The answer depends on your Medicare plan and why you're receiving the vaccination.
What Is Tetanus?
Tetanus is a bacterial infection that causes severe muscle contractions. The condition is sometimes referred to as lockjaw because it often causes locking of the infected person's jaw and neck muscles, making it difficult to open and close their mouth. Tetanus typically occurs when Clostridium tetani bacteria enter the body through a burn or puncture wound.
Although the condition is relatively uncommon, tetanus may also infect a person through other means, including:
- Insect bites
- Chronic sores
- Crush injuries
- Surgical procedures
- Compound bone fractures
- IV drug use
Does Medicare Cover Tetanus Shots?
Potential Exposure to Bacteria
If you've been bitten by an animal, stepped on rusted metal or have another high-risk injury, your physician may recommend a tetanus shot. A vaccine administered because of potential exposure to Clostridium tetani bacteria is considered medical treatment, and as such, it's covered under Medicare Part B. Medicare Advantage plans, which are also known as Medicare Part C plans, typically also cover medically necessary tetanus shots.
The CDC recommends that all individuals receive an initial tetanus shot and a booster every 10 years to maintain immunity to the disease. If a tetanus shot is received as part of routine preventative care, coverage falls under Part D, Medicare's prescription drug plan.
Coverage through Part D is subject to the terms of your individual plan, which may include a copay or deductible. If you have a Medicare Advantage plan, reimbursement for the vaccine depends on whether your plan includes prescription drug coverage.
Are All Tetanus Shots the Same?
No. Tetanus vaccines are typically combined with vaccines that prevent other illnesses. The two main types of combination vaccines that protect against tetanus are:
- Tetanus and diphtheria vaccines (TD or Td vaccines)
- Tetanus, diphtheria and pertussis vaccines (Tdap or DTaP vaccines)
Depending on the dose of vaccine included in a shot, immunization may either provide or boost immunity. For example, the DTap shot is used as an initial vaccine to provide immunity for tetanus, diphtheria and pertussis while Tdap serves as a booster shot to help an individual maintain immunity for those diseases.
How Much Do Tetanus Shots Cost Through Medicare?
If you have Medicare coverage, the cost of a tetanus shot varies depending on why you're receiving it.
- Medical necessity: If you're receiving the vaccine as the result of an injury, you must meet your $203 Part B deductible before Medicare pays for the cost of the shot. If your deductible has been met, you'll be responsible for paying 20% of the Medicare-approved cost of the vaccine.
- Preventative care: If you're receiving the vaccine as part of your routine preventative care program, the amount you'll pay is subject to the terms of your Part D plan, including any applicable copays and deductibles.
Because Medicare Advantage is administered by private insurance companies, beneficiaries with MA plans should refer to the terms of their policies for costs and other coverage guidelines.
If you have a supplemental Medigap plan, it may cover some or all of the out-of-pocket expenses left after your Medicare coverage. That may include any copays and deductibles.
How Much Does a Tetanus Shot Cost If I Don't Have Medicare?
If you have private health insurance, you'll probably pay between $10 and $40 for a tetanus shot, which includes the cost of the office visit. If you don't have a health insurance policy, you'll probably have to pay out-of-pocket for a tetanus shot, and costs typically range between $25 and $60. This typically includes any associated administrative fees.
Where Can I Get a Tetanus Vaccine?
If you've been injured and suspect you need a tetanus vaccine, seek immediate care at a hospital or urgent care center. In addition to administering a tetanus vaccine, these facilities can provide other acute care services as needed. Your physician's office can also provide medically necessary tetanus vaccines.
If you aren't injured and want to receive a tetanus vaccine as a preventative measure, you should contact your primary care physician to schedule an appointment. Many local pharmacies now offer on-site vaccinations as well.
Medicare beneficiaries who want their health plan to cover the cost of the vaccine should schedule their tetanus shots at a Medicare-approved facility.
How Do I Bill Medicare for a Tetanus Shot?
Because Original Medicare requires approved providers and facilities to submit claims directly to the program, beneficiaries are rarely responsible for billing Medicare. If you notice that a claim hasn't been filed, contact your provider to request that they do so.
If your provider refuses to file a claim, you may call 1-800-MEDICARE for instructions on how to submit a claim directly. You may also fill out the Patient's Request for Medical Payment form and submit it with the appropriate information, which may include:
- An itemized bill from the provider
- A letter explaining why you're submitting the claim directly
- Any supporting documentation
If you have a Medicare Advantage plan that lets you seek out-of-network care, contact your insurance carrier directly to find out more about submitting claims.