Does Medicare Cover the Measles Vaccine? 

With an uptick of measles cases in 2023, it’s important to understand what vaccines and treatments are available for the disease. The measles virus (rubeola) is a highly contagious respiratory illness that can affect people of all ages. Signs and symptoms of infection include the virus’ trademark skin sores, coughing, fever and muscle pain. Although most people can overcome a measles infection on their own, the disease can be dangerous for young children, seniors and people with compromised immune systems.

How is measles treated?

Treatment for measles generally consists of rest and hydration. Over-the-counter (OTC) fever reducers may also be beneficial to ease symptoms. Unfortunately, because a virus causes measles, no medications are available to counteract the virus infection itself, so the focus is usually on treating symptoms.

Seniors can prevent a measles infection in the first place by getting vaccinated against the disease. The measles vaccine has been around since the 1960s, and in 1971, the measles, mumps and rubella (MMR) vaccine was introduced. The MMR vaccine inoculates people against all three infections at once. As a side note, rubella and rubeola are two different viruses, but both cause a type of measles.

Does Medicare cover the measles vaccine?

Seniors and retirees concerned about the potential for catching measles are encouraged to get vaccinated if they have not already received any form of the measles vaccine. This, however, calls into question whether Medicare offers benefits for the measles vaccine and, if so, what the costs are for getting vaccinated.

For the most part, Medicare insurance offers coverage for immunizations under Medicare Part B. This is outpatient coverage, and it generally provides benefits for doctor visits, durable medical equipment purchases and rentals as well as lab testing. Along with this coverage, Medicare Part B also covers the administration of prescription medications in an outpatient setting. Things like drug infusions and injections are covered under Medicare Part B, and this part of Medicare also covers vaccinations in most cases.

Medicare Part D and measles vaccine coverage

Interestingly, Original Medicare does not cover the measles vaccine under Part B despite providing coverage for the flu vaccine and vaccination against hepatitis under Part B. Medicare insurance does, however, cover the measles vaccine under Part D, the prescription drug benefit.

In most cases, Medicare Part D supplies benefits for prescription drugs that can be purchased from retail pharmacy locations in the United States. This generally covers prescription medications that can be bought from a local or online pharmacy for use at home. Medicare Part D does, however, cover some injectable medications administered by clinical professionals. The measles vaccine happens to be one of these vaccines.

Under Medicare Part D, costs can vary depending on your plan. In addition, you must pay a monthly premium to carry Medicare Part D. Medicare recipients must also meet an annual deductible before benefits apply toward the measles vaccine. The highest a Part D deductible can be in 2023 is $505, but your premium can vary depending on your income. Some Medicare recipients will end up paying an additional premium on top of their plan premiums. This is often the case for Medicare recipients with a high income level as reported on annual tax return filings.

How does Medicare cover measles treatment?

If you receive Medicare benefits and contract measles, you’ll be happy to know that Medicare insurance covers measles treatment in several ways. As mentioned, there is no cure for measles, but treatment may consist of medicinal support and monitoring. If you require inpatient care after contracting measles, Medicare Part A supplies coverage for a hospital stay or care in a skilled nursing facility.

Medicare Part B will pay for 80% of outpatient costs, including costs incurred through doctor visits or visits with a Medicare-participating healthcare specialist. Medicare coverage is not available for OTC medications used to treat the symptoms of measles, but a Medicare Advantage plan may offer additional options on top of those provided through Original Medicare. A Medicare Advantage plan may provide rebates or coupons to purchase certain OTC medications, but these types of benefits are specific to your plan provider.