Vaccine Coverage for Medicare Supplement Members

For All Medicare Members With Part B:

Flu and pneumococcal vaccines are covered at 100% if the provider accepts Medicare assignment.

HealthChoice Employer PDP Medicare Supplement With Part D Members:

You must obtain vaccines such as Zostavax, Tetanus, and Hepatitis A and B at your local pharmacy. The cost is covered under your pharmacy benefit and the appropriate copays apply. The vaccine administration fee, if given by either your physician or a pharmacist certified to administer (inject) vaccines, is also reimbursed under your pharmacy benefit. This is how it works:

• If the vaccine is obtained and administered by a certified pharmacist, the pharmacist electronically submits a claim to Medco for both the vaccine and the administration fee.
• If you obtain the vaccine from your pharmacy and take it to your physician’s office for administration, your pharmacy electronically submits a claim to Medco for the vaccine; however, you must to file a paper claim with Medco for reimbursement of the administration fee.

To obtain a paper claim form, you can contact OSEEGIB Member Services or on this website, click Member in the top menu bar then click Medicare Members, scroll down to Forms and Applications, and click on Vaccine Claim Form and How to Request Coverage for Vaccines. Print the form and follow the step-by-step instructions. You can also contact Medco Member Services toll-free at 1-800-590-6828 or TDD toll-free 1-800-716-3231 to obtain the required claim form.

HealthChoice Medicare Supplement Without Part D Members:

Vaccines such as Zostavax, Tetanus, and Hepatitis A and B must be purchased at your pharmacy to be covered by your pharmacy benefit. Once you obtain the vaccine from your pharmacy, the pharmacist will electronically submit a claim to Medco.

Typically, Medicare Part B covers the administration fee for all vaccines. The administration fee is not covered under the pharmacy benefit.

For more information, contact Medicare toll-free at 1-800-633-4227 or TTY toll-free 1-877-486-2048.