Prescription Drug Coverage
Vaccine Coverage
Getting the vaccinations you need is important for your best health.
Getting vaccines administered at the right location is important for your best coverage. Learn about your vaccine coverage, administration options, and what you should expect to pay below. Our plan covers most Part D vaccines at no cost to you. We understand the rules for coverage of vaccinations are complicated. That’s why we are here to help. Call Customer Service when you are planning to get a vaccination. We are available 24 hours a day, seven days a week.
There are Two Parts to Vaccination Coverage:
- The first part of coverage is the cost of the vaccine itself. A vaccine is a prescription medication.
- The second part of coverage is the cost of your provider giving you the vaccination shot. (This is called the “administration” of the vaccine.)
Questions?
We’re a phone call away.
PPO Members:
HMO Members:
What you pay at the time you get a Part D vaccination varies depending on the circumstance.
Sometimes when you get your vaccine, you will have to pay the entire cost for both the vaccine medication and for getting the vaccine shot. You can ask our plan to pay you back for our share of the cost. Other times, when you get the vaccine medication or the vaccine, you will pay only your share of the cost.
Whether the vaccine is recommended for adults by an organization called the Advisory Committee on Immunization Practices (ACIP).
Most adult Part D vaccinations are recommended by ACIP and cost you nothing.
Where you get the vaccine medication
The vaccine itself may be dispensed by a pharmacy or provided by the doctor’s office.
Who administers the vaccine
A pharmacist or another provider may give the vaccine in the pharmacy. Alternatively, a provider may give it in the doctor’s office.
What you pay at the time you get the Part D vaccination can vary depending on the circumstances and what drug payment stage you are in.
3 Options to Get Your Vaccine
There are three ways to get your Part D vaccines. Each is different in terms of what you pay up front versus what you can be reimbursed for later.
Receive the vaccine at a network pharmacy.
Some pharmacies do not administer vaccines, so you’ll want to check with yours in advance to make sure they can provide the vaccination.
Receive the vaccine at your doctor’s office.
You may have to pay for the full cost of the vaccine and vaccine administration, but in most cases you can be reimbursed.
Buy the vaccine at a network pharmacy and take it to your doctor’s office to have it administered.
You may have to pay for the full cost of vaccine administration, but in most cases you can be reimbursed.
DID YOU KNOW?
Some vaccines are covered under your Advantage MD Part B coverage, not Part D.
Part B vaccines are available from your provider’s office or a network pharmacy. Show the pharmacist your Advantage MD card to receive these vaccinations at no cost to you. The following vaccines and their administrations are covered under your Advantage MD Part B medical benefit:
- Influenza
- Pneumococcal
- COVID-19
Frequently Asked Questions About Vaccines
What is a vaccine or immunization?
A vaccine is a type of medicine that is usually given to you as a shot with a needle. The medicine in the shot protects your body from one or more diseases. When you get this medicine, your body learns how to fight the disease so that you will not get sick from it. This is called “immunization.”
Are vaccines safe?
Yes. Vaccines are very safe. If any side effects occur from vaccinations, they are very minor, such as soreness where you received the shot, fussiness; or a low-grade fever. Serious side effects, like allergic reactions, are very rare, and doctors are trained to treat them.
Why do we get the same shot more than once?
Some vaccines take more than one dose to give you full protection. Other vaccines stop working after a while, so you need to get them again. Make sure that you get every dose of all of your vaccines. This is the only way to make sure that you are protected from the disease.
How do I get reimbursed for vaccines?
Sometimes when you get a vaccine and/or the shot at a non-network pharmacy or at the physician’s office, you may need to pay the full cost right away. Other times, you may find that you have paid more than expected under the coverage rules of the plan. In either case, you can ask our plan to pay you back (reimburse).
To speed up the reimbursement process and to make sure that you are giving us all the information we need, you should complete the Medicare Part D Prescription Claim Form and send this form along with a detailed receipt for the vaccine and the pharmacy label, or your pharmacy prescription claim history to us. (The pharmacy label is generally attached to your prescription bag when you pick up your medication and includes the name of the drug, quantity, date of purchase, and cost of the drug. Your pharmacy prescription claim history is a print out of what prescription you filled and paid for.)
You do not have to use the Medicare Part D Prescription claim form, but the use of this form will speed up the reimbursement process.
Medicare Part D Prescription Claim Form
Please mail your request for payment together with any receipts to:
Johns Hopkins Advantage MD
c/o CVS/caremark Part D Services
PO BOX 52066
Phoenix, AZ 85072-2066
If you have any questions, you can call Customer Service 24 hours a day, seven days a week.
PPO members: call 877-293-5325 (TTY: 711).
HMO members: call 877-293-4998 (TTY: 711).
See Chapter 7 of your Evidence of Coverage for additional information on the reimbursement process.
Please note: the information in this section does not apply to Advantage MD Group.
How do I know which vaccines are covered by Part D?
Part D vaccines are listed in your plan’s formulary.
- PPO and Plus (PPO) formulary – English | Spanish
- Primary (PPO) formulary
- HMO formulary
- Select (HMO) formulary
- D-SNP (HMO) formulary
Are all vaccines covered under Part D?
No, the following vaccines and their administrations are covered under your Advantage MD Part B medical benefit:
- Influenza
- Pneumococcal
- COVID-19
Part B vaccines are available from your provider’s office or a network pharmacy. Show the pharmacist your Advantage MD member ID card to receive these vaccinations at no cost to you.
