Medicare vaccine coverage Part B and Part D in NC

Medicare vaccine coverage Part B and Part D splits adult shots into two lanes, and the lane decides which card the pharmacy bills. You pay nothing, and the Part B deductible does not apply, for COVID-19, flu, pneumococcal, and hepatitis B vaccines if your provider accepts assignment [1]. Part D generally covers other adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), including shingles, respiratory syncytial virus (RSV), and whooping cough, and your drug plan will not charge a copayment or deductible for vaccines ACIP recommends [1]. If you have Original Medicare, you can join a separate Medicare drug plan to get that drug coverage [1]. North Carolina does not keep a separate Original Medicare vaccine list. These rules are federal.

Two cards, two parts of Medicare

Part B is medical insurance. It helps pay for doctor and provider services, outpatient care, and many preventive services, including certain shots [2]. Part D is drug coverage. You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage plan that includes drug coverage [2]. Those drug plans are run by private companies that follow rules set by Medicare [2]. A Part B shot is billed as medical care. A Part D shot is billed as a drug benefit.

Medicare is federal health insurance for people age 65 and older, and for some people under 65 with certain disabilities or conditions [2]. Greensboro, High Point, Winston-Salem, and the rest of the Piedmont Triad use that federal split. North Carolina does not add its own Original Medicare vaccine list.

Vaccines Part B covers

Medicare's preventive guide puts four preventive vaccines under Part B: COVID-19, flu, hepatitis B, and pneumococcal disease [3]. You pay nothing, and the Part B deductible does not apply, for those four if your provider accepts assignment [1]. If the provider does not accept assignment, that "you pay nothing" line does not automatically apply. Ask before the shot is given. Hepatitis B also has eligibility limits, described below.

Seasonal flu

Part B covers the seasonal flu vaccine [4]. Flu vaccines can keep you from getting sick with seasonal influenza during the fall and winter [4]. For the 2026-2027 season, you can get a trivalent flu vaccine that protects against 3 different flu viruses [4]. People 65 and older can get a trivalent flu vaccine to lower the risk of hospital visits and death, and Medicare's flu page calls that vaccine safe and effective [4]. You pay nothing for a flu shot if your doctor or other health care provider accepts assignment [4]. You can get it at a doctor's office or a local pharmacy, usually one vaccine each flu season [4].

COVID-19

Part B covers FDA-approved and FDA-authorized COVID-19 vaccines, including the updated 2025-2026 formula Moderna, Pfizer-BioNTech, or Novavax vaccine for anyone who has Medicare [5]. Medicare lists Moderna Spikevax for anyone 6 months or older, Moderna mNexspike for anyone 12 years or older, Pfizer-BioNTech for anyone 5 years or older, and Novavax for anyone 12 years or older, and it points readers to CDC.gov for the schedule [5]. You pay nothing if your doctor or other health care provider accepts assignment for giving the vaccine [5]. Bring the red, white, and blue Medicare card so the provider or pharmacy can bill Medicare [5].

Pneumococcal vaccines

Part B covers pneumococcal vaccines, which protect against different strains of the bacteria that cause pneumonia [6]. The coverage page does not name a brand or a dose number. Talk with your doctor or other health care provider about which vaccines are right for you [6]. You pay nothing if that provider accepts assignment [6]. If a clinic quotes a cash price, ask whether it can bill Part B and whether it accepts assignment before you pay.

Hepatitis B, when you qualify

Part B covers hepatitis B vaccines if you are eligible [7]. The vaccines help protect against the hepatitis B virus [7]. You must meet at least one condition: you have never gotten a complete series, you do not know your vaccination history, or a health condition or situation puts you at medium or high risk [7]. Medicare's examples of that risk include diabetes, end-stage renal disease, and living with someone who has hepatitis B [7]. You pay nothing if your doctor or other health care provider accepts assignment [7].

If you already finished the series, you know that history, and you are not at medium or high risk, you may not meet the Part B rule. Ask whether a dose is recommended before anyone bills it.

An injury shot and a routine booster are not the same bill

Part B also covers some vaccines when they are directly related to treating an injury or illness [1]. The preventive guide names tetanus as an example of a non-preventive vaccine Part B covers when it is related directly to treatment of an injury or illness [3]. A routine Tdap booster is on the Part D list, not the Part B preventive list [3]. Tell the clinic why you are there, because the reason for the visit changes which part is billed.

Vaccines that usually fall under Part D

Part D covers all adult vaccines recommended by ACIP that are not already covered under Part B [8]. The preventive guide names RSV, shingles, Tdap, measles, and travel vaccines such as yellow fever and chikungunya in that group [3]. Your Part D plan will not charge a copayment or apply a deductible for vaccines ACIP recommends [8].

That cost rule comes from the Inflation Reduction Act of 2022. In an April 4, 2025 final rule, CMS codified the requirement that, for plan years beginning on or after January 1, 2023, the Part D deductible does not apply, and there is no cost sharing, for an adult vaccine recommended by ACIP and covered under Part D [9]. The consumer pages say you pay nothing if you have Part D [8] [10] [11]. They do not say you pay nothing with Part B alone.

Shingles

Part D covers the shingles vaccine [8]. It can protect you against the varicella-zoster virus that causes a painful skin rash and sometimes long-term pain [8]. People often ask us for it by the pharmacy name Shingrix. You pay nothing for the shingles vaccine if you have Part D [8].

RSV

Part D covers the RSV vaccine [10]. These vaccines can protect you from RSV, a respiratory virus that causes cold-like symptoms [10]. Medicare Advantage plans that include drug coverage also cover drug benefits like the RSV vaccine [10]. You pay nothing for the RSV vaccine if you have Part D [10].

Adults 75 and older, and adults between 50 and 74 with certain conditions, are at high risk of serious complications from RSV [10]. Whether you should get the shot is a question for your doctor or other health care provider [10]. You can get it at a doctor's office or a local pharmacy [10].

Tdap

Part D covers the Tdap vaccine [11]. Tdap is the booster that protects against tetanus, diphtheria, and pertussis, also called whooping cough [11]. You pay nothing for the Tdap vaccine if you have Part D [11]. As with the other Part D shots on this list, the plan will not charge a copayment or apply a deductible for vaccines ACIP recommends [11].

Original Medicare needs a drug plan for those shots

Original Medicare is Part A and Part B [2]. Drug coverage is something you add. If you have Original Medicare, you can join a Medicare drug plan [1]. That drug coverage is optional, and it is available to everyone with Medicare [12].

A Medigap policy is not a drug plan. It is extra insurance you may buy to help pay your share of Original Medicare costs, and Medigap policies generally do not cover prescription drugs [12]. The shingles, RSV, and Tdap pages each tie "you pay nothing" to having Part D [8] [10] [11]. Ask the pharmacy to check drug coverage before the shot.

Medicare Advantage follows the plan you joined

Medicare Advantage is the other way to receive Medicare. You join a Medicare-approved plan from a private company that includes Part A and Part B, and most plans include Part D [12]. In many cases you can only use doctors in the plan's network [12]. Our page on Medicare Advantage (MAPD) plans explains how those plans package medical benefits and, often, drug coverage.

Plans must cover all emergency and urgent care, and almost all medically necessary services Original Medicare covers [13]. They usually bundle Part D as well [13]. That does not mean every plan bills every vaccine the same way. If you have a Medicare Advantage plan, another Medicare health plan, or both Medicare and Medicaid, coverage, costs, and rules might be different, so check with the plan [3]. Medicare says plans that include drug coverage cover drug benefits like the RSV vaccine, and you pay nothing for that vaccine if you have Part D [10]. Shingles and Tdap use the same condition [8] [11]. In most types of Medicare Advantage plans, you cannot join a separate drug plan [12]. If a bill arrives anyway, call the plan before you pay.

What this means in North Carolina

Medicare is federal health insurance, so North Carolina does not have a separate Original Medicare vaccine list [2]. The Part B and Part D lists above are the lists in Greensboro and the Piedmont Triad. Networks and preferred pharmacies differ by county. That is plan design, not a state vaccine law. If you live in another state for part of the year, check whether the plan will cover you there [14].

A plain fall calendar

Flu, COVID-19, and pneumococcal vaccines do not require a drug plan [1] [4] [5] [6]. Shingles, RSV, and Tdap do [3] [8] [10] [11]. If a parent on Original Medicare still needs one of those Part D shots and has no drug plan, the ordinary annual window is Open Enrollment, October 15 through December 7 [14]. In that period you can join, drop, or switch a Medicare Advantage plan, move between Original Medicare and Medicare Advantage, or join, drop, or switch a Medicare drug plan if you are in Original Medicare [14]. If the plan gets the enrollment request by December 7, coverage starts January 1 [14].

Each year you can choose how you get Medicare coverage and add or switch drug coverage [13]. Before a Part D vaccine, confirm Part D is in place, standalone or inside the Medicare Advantage plan.

Practical takeaways

• Part B is the lane for flu, COVID-19, pneumococcal vaccines, and hepatitis B when you qualify. You pay nothing for those four, and the Part B deductible does not apply, if the provider accepts assignment [1].
• Part D is the lane for shingles, RSV, and Tdap. You pay nothing for those vaccines if you have Part D, and the plan does not charge a copayment or deductible for ACIP-recommended vaccines [8] [10] [11].
• Original Medicare does not include Part D by itself. You join a drug plan for the Part D shots, and a Medigap policy generally does not cover prescription drugs [1] [12].
• A Medicare Advantage plan includes Part A and Part B, most include Part D, and in most plan types you cannot add a separate drug plan. Confirm the network, and ask the plan how it wants the shot billed [3] [12].
• A tetanus shot tied to an injury can be Part B, while a routine Tdap booster is Part D. Tell the clinic the reason for the visit [3].
• North Carolina does not have its own Original Medicare vaccine list. Federal Part B and Part D rules are the rules here [2].
• This fall, the flu shot is a Part B visit, and October 15 through December 7 is Open Enrollment if someone still needs drug coverage for a Part D vaccine [4] [14].

How we can help

Have more questions or want to get in touch? Families across Greensboro and the Piedmont Triad ask us which card to take to the pharmacy, and whether Original Medicare still needs a drug plan for a Part D vaccine [1]. Call (336) 937-7501 or visit https://thesih.com/contact/ and we will look at the coverage you have now [1].

Citations

1. Medicare.gov, "Prescription drugs (outpatient)" (2026)
2. Medicare.gov, "Parts of Medicare" (2026)
3. Medicare.gov, "Your Guide to Medicare Preventive Services" (2026)
4. Medicare.gov, "Flu vaccines" (2026)
5. Medicare.gov, "Coronavirus disease 2019 (COVID-19) vaccine" (2026)
6. Medicare.gov, "Pneumococcal vaccines" (2026)
7. Medicare.gov, "Hepatitis B vaccines" (2026)
8. Medicare.gov, "Shingles vaccines" (2026)
9. CMS, "Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (CMS-4208-F)" (2025)
10. Medicare.gov, "Respiratory Syncytial Virus (RSV) Shot" (2026)
11. Medicare.gov, "Tdap vaccines" (2026)
12. Medicare.gov, "Your coverage options" (2026)
13. Medicare.gov, "How does Medicare work?" (2026)
14. Medicare.gov, "Joining a plan" (2026)