2023 Vaccine Coverage

This option depends on the 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.

• For most adult Part D vaccines, you will pay nothing.
• For other Part D vaccines, you will pay the pharmacy your copayment for the vaccine itself which includes the cost of giving you the vaccine.
• Our plan will pay the remainder of the costs.

• When you get the vaccine, you may have to pay for the entire cost of the vaccine itself and the cost for the provider to give it to you.
• You can then request reimbursement for the plan’s share of the cost by filling out a Medicare Part D prescription claim form and following our reimbursement procedure outlined in the FAQs below.
• For most adult Part D vaccines, you will be reimbursed the full amount you paid. For other Part D vaccines, you will be reimbursed the amount you paid less any copayment for the vaccine (including administration). (If you get “Extra Help,” we will reimburse you for this difference.)

• Medicare Part D Prescription Claim Form

• For most adult Part D vaccines, you will pay nothing for the vaccine itself.
• For other Part D vaccines, you will pay the pharmacy your copayment for the vaccine itself.
• When your doctor gives you the vaccine, you may have to pay the entire cost for this service.
• You can then request reimbursement for the plan’s share of the cost by filling out a Medicare Part D prescription claim form and following our reimbursement procedure outlined in the FAQs below.

• Medicare Part D Prescription Claim Form

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 card to receive these vaccinations at no cost to you.

Part D vaccines are listed in your plan’s formulary.

• PPO, PPO Plus, PPO Premier formulary – English | Spanish
• PPO Primary formulary
• HMO formulary
• HMO D-SNP formulary – English | Spanish

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.