2008 vaccine reimbursements

Paying for vaccines in 2008

In 2007, doctors had to bill the cost of a vaccine to Medicare Part D and the administration of the vaccine to Medicare Part B. Beginning January 1, 2008, the Medicare Part D program will cover both the cost of a covered vaccine and the other costs associated with it, including the vaccine administration fee, a dispensing fee (if applicable) and sales tax (if applicable).

If the vaccine you need is covered by Part D (see below), here's how to make sure your PriorityMedicare^SM plan pays for it:

• Option 1: We reimburse you
  When your doctor or other health care provider gives you a vaccination, pay them directly for both the vaccine and the administration of the vaccine. Then you can ask PriorityMedicare to reimburse you by filling out and sending in a Member Reimbursement claim form. Your deductible, coinsurance and copay will apply.
  Print a Member Reimbursement form (99KB PDF)
• Option 2: Use a Vaccine Network pharmacy, which bills us directly
  If you get your vaccination at one of the more than 700 pharmacies in our Michigan-wide Vaccine Network, then the pharmacy can bill us directly. You don't need to fill out a Member Reimbursement form. Your deductible, coinsurance and copay will apply. To find a pharmacy near you that's in the Vaccine Network, check the updated Pharmacy Directory (1.2MB PDF) and look for this symbol or call Customer Service.

Part B vs Part D vaccines

For 2008, if a vaccine is covered under Part B, it will continue to be covered under Part B regardless of the Part D vaccine administration changes for 2008.

Medicare Part Part B-covered vaccines:

• Influenza (flu) vaccine
• Pneumococcal pneumonia vaccine
• Hepatitis B vaccine for individuals at high or intermediate risk
• Other vaccines when they're medically necessary to treat an illness or injury

Medicare Part D-covered vaccines: Look in our approved drug list under Immunological Agents.


You'll need Adobe® Reader software to view and print PDF files. Download it free now!