Medicare Advantage vaccine coverage from WellFirst Health — Provided by SSM Health Plan

How are vaccinations covered? 

Members can find covered vaccines listed in our formulary. A new preventive vaccine may not specifically appear in the formulary, but we may still cover the vaccine. Contact our Customer Care team at 1-877-232-7566 (TTY: 711) to find out about coverage.

Medicare Part B provides preventive coverage for certain vaccines, which includes:

• Influenza: once per flu season
• Pneumococcal: once per lifetime with high-risk booster after five years
• Hepatitis B: for persons at intermediate- to high-risk
• Other immunizations are covered under Medicare Part B only for those who meet coverage rules and are at high risk

Medicare Part D: See your formulary for a full list of covered Part D vaccines.

We cover Shingles and tetanus, diphtheria and acellular pertussis (Tdap) vaccines at no cost to you under the Part D benefit. These $0 vaccines are listed in our formulary as Tier 6.

For the best benefit under your Part D plan, receive your vaccine from a network pharmacy that employs pharmacists certified to administer vaccines. Search our pharmacy directory to find network pharmacies in your area or contact our Customer Care Center at 1-877-301-3326 (TTY: 711). 

Receiving your Part D vaccines in a physician’s office may mean you are financially responsible for the cost of the services and will need to submit claims on your own.

Learn more about the benefits of vaccines and immunization from the Centers for Disease Control and Prevention (CDC): Vaccines and Immunizations: The Basics.