Georgia Medicare Vaccines $0 Cost-Sharing: ACIP-Recommended Vaccine Coverage

::: hero

By Brevy Care Team · Last verified May 13, 2026

For Georgia Medicare beneficiaries, the Inflation Reduction Act of 2022 closed a long-standing coverage gap by eliminating all beneficiary cost-sharing for adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) when those vaccines are covered under Medicare Part D. Effective January 1, 2023, Georgia beneficiaries who receive ACIP-recommended Part D vaccines at any in-network pharmacy or physician office pay $0: no deductible, no coinsurance, no copayment. The reform addresses a structural problem in Medicare vaccine coverage that public health authorities and patient advocacy organizations had flagged for years.

Before 2023, Medicare's vaccine coverage was bifurcated. Part B, established under Section 1861(s)(10) of the Social Security Act and modified by the Affordable Care Act of 2010, covered influenza, pneumococcal, hepatitis B for high-risk populations, and COVID-19 vaccines at $0 cost-sharing. Part D, established by the Medicare Modernization Act of 2003, covered most other ACIP-recommended adult vaccines (shingles, Tdap, MMR, HPV, RSV, hepatitis A, meningococcal) but with substantial cost-sharing. Shingrix, particularly important for older adults given the doubled shingles risk after age 50, frequently required significant out-of-pocket payment per dose (and Shingrix requires two doses for the full series). Federal data documented that vaccine uptake dropped sharply once cost-sharing applied.

Section 11401 of the IRA, codified at Section 1860D-2(b)(3)(D) of the Social Security Act and Section 1860D-2(b)(8)(B) (for the deductible waiver), eliminated this cost-sharing for ACIP-recommended adult vaccines. The reform was estimated to benefit millions of Medicare beneficiaries nationwide annually. The provision works by shifting the beneficiary cost share to the plan (and ultimately to Medicare reinsurance), preserving plan coverage decisions while removing the financial barrier at the point of care.

This guide explains the federal framework for Medicare vaccine coverage, walks through the distinction between Part B and Part D vaccines, details the ACIP recommendation process and the specific vaccines covered, examines the operational mechanics for both pharmacy and physician office administration, provides Georgia-specific implementation context, and offers six worked examples for typical Georgia Medicare beneficiary vaccination scenarios.

Georgia Medicare Vaccines $0 Cost-Sharing at a glance

• Federal authority: Section 11401 of the Inflation Reduction Act 2022 (Public Law 117-169), implemented through Section 1860D-2(b)(3)(D) of the Social Security Act for Part D vaccine cost-sharing and Section 1860D-2(b)(8)(B) for the deductible waiver. Part B vaccines (influenza, pneumococcal, hep B high-risk, COVID-19) have been $0 since the Affordable Care Act 2010.
• Effective date: January 1, 2023, for Part D ACIP-recommended adult vaccines.
• Cost to beneficiary: $0. No deductible, no coinsurance, no copayment.
• Vaccines covered under Part D (now $0): Shingrix, Tdap, Td, MMR adult catch-up, HPV, RSV (Arexvy, Abrysvo, mRESVIA), hepatitis A, meningococcal (MenACWY, MenB), and other ACIP-recommended adult vaccines.
• Vaccines covered under Part B ($0 always): Seasonal influenza, pneumococcal (PPSV23, PCV15, PCV20), hepatitis B for high-risk, COVID-19.
• Where to get vaccinated: Any in-network Georgia pharmacy (CVS, Walgreens, Walmart, Kroger, Publix, others) or participating physician office. Both pathways are $0.
• For Georgia families: The reform eliminates out-of-pocket costs for vaccines like Shingrix, Tdap, and RSV. GeorgiaCares (1-866-552-4464) provides free counseling. :::

::: callout type="key-fact" Key facts about Georgia Medicare vaccine coverage

• IRA Section 11401 eliminated all cost-sharing for ACIP-recommended adult vaccines under Medicare Part D effective January 1, 2023.
• Both Part B vaccines (flu, pneumococcal, hep B high-risk, COVID-19) and Part D ACIP-recommended vaccines are now $0.
• No deductible, no coinsurance, no copayment — and no prior authorization required.
• Georgia beneficiaries can get vaccinated at any in-network pharmacy or participating physician office at $0. :::

Federal framework: Section 11401 and the elimination of Part D vaccine cost-sharing

To understand the new $0 cost-sharing landscape, it helps to start with how Medicare vaccine coverage was structured before the Inflation Reduction Act. Medicare vaccine coverage has long been split between Part B and Part D based on the type of vaccine and the clinical setting in which it is administered.

Part B vaccines: $0 since the Affordable Care Act

Section 1861(s)(10) of the Social Security Act, modified by the Affordable Care Act of 2010, established $0 cost-sharing for the following preventive vaccines covered under Part B:

• Seasonal influenza (annual)
• Pneumococcal: PPSV23 (Pneumovax 23), PCV15 (Vaxneuvance), PCV20 (Prevnar 20)
• Hepatitis B for high-risk populations
• COVID-19 (added during pandemic)

Part B vaccines are administered through physician offices, pharmacies, and other Medicare providers. The vaccine and administration are reimbursed by Medicare directly, with no beneficiary cost. The Part B deductible does not apply to these preventive vaccines.

Part D vaccines: cost-sharing eliminated by IRA Section 11401

The Inflation Reduction Act 2022 Section 11401 amended Section 1860D-2(b)(3)(D) of the Social Security Act to require Medicare Part D plans (both standalone PDPs and Medicare Advantage MA-PDs) to provide ACIP-recommended adult vaccines at $0 cost-sharing. The amendment also added Section 1860D-2(b)(8)(B) to waive the Part D annual deductible for these vaccines.

Before this change, Part D vaccines often required:

• Substantial cost-sharing (often 25% coinsurance on Tier 3 brand placement)
• Application against the annual deductible (the beneficiary would pay full vaccine cost until deductible satisfied)
• Coverage gap considerations (in the pre-2025 donut hole era)
• Step therapy or prior authorization in some plans

After IRA Section 11401:

• $0 cost-sharing
• No deductible application
• No prior authorization for ACIP-recommended vaccines
• No step therapy for ACIP-recommended vaccines

The two provisions, Section 1860D-2(b)(3)(D) and Section 1860D-2(b)(8)(B), work together to eliminate financial barriers at the pharmacy counter or physician office. Georgia beneficiaries who walk into a Walgreens for Shingrix pay $0; those who go to their physician for the same vaccine pay $0.

The Advisory Committee on Immunization Practices (ACIP)

The Advisory Committee on Immunization Practices (ACIP) is a federal advisory committee at the Centers for Disease Control and Prevention (CDC). ACIP develops recommendations for vaccine use in the United States, publishes those recommendations in the Morbidity and Mortality Weekly Report (MMWR), and the recommendations are then incorporated into the US adult immunization schedule.

ACIP recommendation process

• ACIP meets approximately three times per year
• Working groups evaluate evidence for new and existing vaccines
• ACIP votes on recommendations
• CDC Director approves recommendations
• Recommendations published in MMWR Recommendations and Reports
• Implementation begins after recommendation publication

Adult immunization schedule (2026)

The 2026 adult immunization schedule, updated annually based on ACIP recommendations, can be found at cdc.gov/vaccines/schedules/hcp/imz/adult.html. Major elements for Georgia Medicare beneficiaries:

• Tdap: every 10 years (after primary series)
• Influenza: annually
• Pneumococcal: PCV15 + PPSV23 OR PCV20 alone for adults 65+
• Shingrix: 2-dose series for adults 50+
• RSV: single dose for adults 60+ (universal recommendation 75+ as of 2024)
• Hepatitis B: high-risk adults
• Hepatitis A: high-risk adults and travelers
• HPV: through age 26 routinely, age 27-45 with shared decision-making
• MMR: catch-up if unvaccinated or unsure of immunity
• COVID-19: ongoing with updated boosters

Linking ACIP to IRA Section 11401

The IRA's $0 cost-sharing provision applies to vaccines that are "recommended by ACIP" and covered under Part D. As ACIP recommendations evolve (e.g., new vaccines added, populations expanded), the $0 cost-sharing automatically extends to those new vaccines if they are Part D covered. RSV vaccines, approved by the FDA in 2023 and ACIP-recommended in 2023, became immediately subject to $0 cost-sharing.

Vaccines covered under Medicare Part D at $0 cost-sharing

The following vaccines, when ACIP-recommended for adults and covered under Part D plan formularies, are subject to the $0 cost-sharing requirement. (Note: this list is illustrative; specific plan formularies should be verified.)

Shingrix (zoster vaccine recombinant)

ACIP recommends a 2-dose series for adults 50 and older. Shingrix replaced the older Zostavax vaccine and offers superior protection against shingles.

Pre-IRA cost: Beneficiaries faced substantial out-of-pocket cost per dose at Georgia pharmacies.

Post-IRA: $0 for both doses.

Shingrix is particularly important for Georgia adults given the doubled risk of shingles after age 50 and the severe impact of postherpetic neuralgia (long-lasting pain after shingles outbreak).

RSV vaccines: Arexvy (GSK), Abrysvo (Pfizer), mRESVIA (Moderna)

Respiratory syncytial virus (RSV) vaccines for adults were approved by the FDA. ACIP recommendations support vaccination for adults 60+, including a universal recommendation for adults 75+ and a risk-based recommendation for adults 60–74 with high-risk conditions.

Pre-IRA cost: Vaccines were not available pre-2023.

Post-IRA: $0 starting from FDA approval and ACIP recommendation in 2023.

RSV causes significant respiratory illness in older adults, with thousands of Medicare beneficiary hospitalizations annually. The vaccine reduces hospitalization risk substantially.

Tdap (tetanus-diphtheria-pertussis) booster

ACIP recommends Tdap booster every 10 years after primary childhood series. Adults who haven't had Tdap before are recommended a single dose followed by Td or Tdap every 10 years.

Pre-IRA cost: Beneficiaries faced out-of-pocket costs at Georgia pharmacies.

Post-IRA: $0.

Tdap is particularly important for grandparents around newborns (pertussis transmission risk).

Adult MMR (measles-mumps-rubella) catch-up

ACIP recommends adults born after 1957 without evidence of immunity receive at least one dose of MMR. During measles outbreaks (2024-2025), catch-up vaccination becomes critical.

Pre-IRA cost: Beneficiaries faced out-of-pocket costs per dose.

Post-IRA: $0.

HPV vaccine (Gardasil 9)

ACIP recommends HPV vaccination through age 26 routinely, with shared clinical decision-making for adults age 27-45.

Pre-IRA cost: Beneficiaries faced substantial out-of-pocket costs per dose for the 3-dose series.

Post-IRA: $0 when ACIP-recommended.

Hepatitis A

ACIP recommends hepatitis A vaccine for high-risk adults and international travelers (particularly to developing countries). 2-dose series.

Pre-IRA cost: Beneficiaries faced out-of-pocket costs per dose.

Post-IRA: $0.

Meningococcal vaccines (MenACWY, MenB)

ACIP recommendations for adults are limited and risk-based. When indicated (immunocompromised conditions, complement inhibitor use, asplenia, certain occupations or travel), these vaccines are $0 under Part D.

Other ACIP-recommended adult vaccines

• Mpox vaccine when ACIP-recommended
• Travel vaccines (tick-borne encephalitis, yellow fever) where ACIP recommends and Part D covers
• New vaccines added to ACIP recommendations over time

Vaccines covered under Medicare Part B at $0 cost-sharing

Part B vaccines have been $0 since the Affordable Care Act of 2010 modified the Part B preventive benefit framework.

Seasonal influenza

Annual flu vaccine, available beginning each year in September or October. All Medicare beneficiaries pay $0.

Pneumococcal vaccines

• PPSV23 (Pneumovax 23) for adults 65+ and high-risk adults under 65
• PCV15 (Vaxneuvance) or PCV20 (Prevnar 20) for adults 65+
• Schedule depends on previous pneumococcal vaccination history

Hepatitis B for high-risk

Hepatitis B vaccine for adults at increased risk (healthcare workers, dialysis patients, certain occupations, household contacts of HBV carriers).

COVID-19

COVID-19 vaccines (including updated boosters) covered under Part B at $0 since 2021.

Operational mechanics: how Georgia beneficiaries get vaccinated

At Georgia pharmacies

Georgia pharmacies (CVS, Walgreens, Walmart, Kroger, Publix, Rite Aid, independent community pharmacies) administer most adult vaccines under Georgia's collaborative practice agreements and pharmacist immunization standing orders. The process:

1. Beneficiary calls or walks in
2. Pharmacist verifies eligibility (age, ACIP recommendation, plan coverage)
3. Pharmacist administers vaccine
4. Pharmacy bills the Part D plan (or Part B Medicare for Part B vaccines)
5. Beneficiary pays $0 at counter
6. Pharmacy receives reimbursement plus administration fee from plan or Medicare

Pharmacy administration is generally the most convenient option for Georgia Medicare beneficiaries. Walk-in availability is common; appointments are also available.

At Georgia physician offices

Physicians administer vaccines as part of office visits. The process:

1. Beneficiary's annual wellness visit or sick visit
2. Physician identifies vaccine recommendations
3. Vaccine administered in office
4. Office bills Medicare (Part B or Part D depending on vaccine)
5. Beneficiary pays $0

Some Georgia physician offices prefer to refer Medicare patients to pharmacies for Part D vaccines because of billing complexity. Patients can ask their physician for a recommendation or simply go to a pharmacy.

Pharmacy administration fee

Pharmacies receive an administration fee separately from the vaccine product reimbursement. The beneficiary does not see this fee directly; it is paid by the plan or Medicare. The total cost to beneficiary remains $0.

Mail-order options

Mail-order pharmacies can dispense vaccines, but most vaccines require professional administration. Mail-order typically does not apply to vaccines.

Interactions with other Medicare provisions

$2,000 Part D OOP cap (IRA Section 11201)

ACIP-recommended vaccines are $0 cost-sharing, so they do NOT contribute to the $2,000 OOP cap. The cap protects against accumulation from other drugs (insulin, anticoagulants, biologics, etc.).

Medicare Advantage MA-PD plans

MA-PD plans are subject to the same $0 cost-sharing requirement as standalone PDPs. MA plans cannot impose copayments on ACIP-recommended vaccines. Plans must use in-network providers; out-of-network may not be covered.

Low Income Subsidy (LIS)

LIS recipients pre-IRA already paid minimal copayments on vaccines. Post-IRA, they pay $0 like everyone else.

Prior authorization prohibition

The IRA prohibits prior authorization for ACIP-recommended vaccines under Section 1860D-4. Plans cannot require pre-approval for these vaccines.

Step therapy prohibition

Similarly, step therapy (requiring beneficiaries to try a different vaccine first) is prohibited for ACIP-recommended vaccines.

Public health impact in Georgia

Vaccination rate increases

Federal data and Georgia Department of Public Health surveillance indicate increased vaccination rates for adult vaccines since IRA Section 11401 took effect in January 2023:

• Shingrix uptake among Medicare beneficiaries 50+ increased noticeably
• RSV vaccination rates show rapid adoption after 2023 approval
• Tdap booster compliance improved among adults due for 10-year booster
• HPV catch-up vaccination among adults 27-45 increased

Reduced disease burden

Vaccination reduces hospitalization and severe disease:

• Shingles incidence reduced among vaccinated populations
• RSV hospitalizations among older adults reduced
• Pertussis (whooping cough) outbreaks among adults reduced
• Outbreak response capacity improved (e.g., MMR catch-up during 2024-2025 measles outbreaks)

Estimated beneficiary impact

Millions of Medicare beneficiaries nationwide benefit from the $0 cost-sharing requirement annually, including a substantial population of Georgia Medicare beneficiaries.

Six worked examples: Georgia Medicare beneficiary vaccinations

Worked example 1: Margaret 65 Atlanta Shingrix two-dose series

Margaret, 65, an Atlanta retiree newly Medicare-eligible. ACIP recommends Shingrix for adults 50 and older. Her physician recommends the two-dose series.

Margaret's Shingrix cost:

• Pre-2023: Substantial out-of-pocket cost for both doses in the two-dose series
• 2023+ post-IRA: $0 for both doses
• Result: Complete elimination of out-of-pocket costs for the full series

Margaret completes the series in two visits to her local Walgreens.

Worked example 2: Robert 68 Savannah Tdap booster

Robert, 68, a Savannah retiree, due for his 10-year Tdap booster. He plans to attend his daughter's wedding and meet his newborn grandchild and wants the pertussis protection.

Robert's Tdap cost:

• Pre-2023: Out-of-pocket cost at CVS Pharmacy
• Post-2023: $0
• Result: No out-of-pocket cost every 10 years

Robert receives the booster at his local CVS during a routine prescription pickup.

Worked example 3: Linda 70 Macon RSV vaccine

Linda, 70, a Macon retiree, has COPD and is at increased risk for RSV. Her pulmonologist recommends the Arexvy RSV vaccine.

Linda's RSV vaccine cost:

• Pre-2023: Vaccine not available
• Post-FDA approval (ACIP shared decision-making recommendation, adults 60+): $0 at Publix pharmacy
• Universal recommendation for adults 75+; risk-based 60-74: $0 continues
• Savings: critical preventive care for high-risk patient

Linda gets her single-dose Arexvy at her local Publix pharmacy with no appointment needed.

Worked example 4: Charles 73 Augusta MMR catch-up

Charles, 73, an Augusta retiree, has no childhood MMR record. He volunteers at his grandchildren's school during a 2025 measles outbreak in Georgia and wants to ensure his immunity.

Charles's MMR cost:

• Pre-2023: Out-of-pocket cost per dose
• 2023+ post-IRA: $0
• Outbreak response capacity preserved with no financial barrier

Charles receives MMR at his physician's office during a wellness visit. The physician bills Part D; Charles pays $0.

Worked example 5: Patricia 65 Columbus same-day multiple vaccines

Patricia, 65, a Columbus retiree, visits her local Walmart pharmacy for her annual flu vaccine in October. The pharmacist suggests she also get the COVID-19 booster and start her Shingrix series.

Patricia's same-day vaccine cost:

• Flu (Part B): $0
• COVID-19 booster (Part B): $0
• Shingrix dose 1 (Part D): $0
• Total visit cost: $0
• Pre-2023: Shingrix would have required out-of-pocket payment; flu and COVID-19 were already $0

Patricia returns 2 months later for Shingrix dose 2, also $0.

Worked example 6: Henry 75 Athens hepatitis A travel

Henry, 75, an Athens retiree, planning a trip to Central America for his anniversary. His physician recommends hepatitis A vaccine for travel preparedness.

Henry's hepatitis A cost:

• Pre-2023: Substantial out-of-pocket cost per dose for the 2-dose series
• Post-2023: $0 for both doses
• Result: Complete elimination of out-of-pocket costs for travel preparedness

Henry receives hepatitis A vaccine at his local CVS and returns 6 months later for the booster dose.

What plans cannot do under IRA Section 11401

Plans must comply with several constraints:

• No cost-sharing: $0 means $0. No copayment, no coinsurance.
• No deductible application: Vaccine costs do not count against the Part D annual deductible.
• No prior authorization for ACIP-recommended vaccines: Plans cannot require pre-approval.
• No step therapy: Plans cannot require beneficiaries to try one vaccine before another.
• No formulary exclusion of ACIP-recommended vaccines: While plans have formulary discretion, anti-discrimination rules prevent excluding ACIP-recommended vaccines without medical justification.
• No in-network restrictions for emergency vaccines: For most ACIP-recommended vaccines, in-network rules still apply. However, emergency vaccination (e.g., post-exposure rabies) may apply outside network.

What still requires payment

While ACIP-recommended Medicare vaccines are $0, beneficiaries should be aware of edge cases that may require payment:

• Non-ACIP-recommended vaccines: Some vaccines not on the ACIP adult schedule may have cost-sharing
• Out-of-network administration: Generally not covered; full cost responsibility
• Travel vaccines for personal preference: Travel vaccines where ACIP does not specifically recommend (varies by destination)
• Commercial insurance secondary coverage: If using non-Medicare insurance, different rules may apply

15 common mistakes Georgia beneficiaries make about Medicare vaccines

1. Believing vaccines have cost-sharing under Medicare. Both Part B and Part D ACIP-recommended vaccines are $0 OOP since January 2023 (Part D) or earlier (Part B).

2. Confusing Part B and Part D vaccine coverage. Flu, pneumococcal, hep B (high-risk), and COVID-19 are Part B. Most others are Part D.

3. Not knowing about RSV vaccines. Arexvy (GSK), Abrysvo (Pfizer), and mRESVIA (Moderna) approved 2023 for adults 60+, universal at 75+ as of 2024.

4. Thinking Shingrix has different costs for first vs second dose. Both doses are $0 post-IRA.

5. Believing pharmacists cannot administer all adult vaccines. In Georgia, pharmacists administer all major adult vaccines under standing orders.

6. Missing the deductible waiver. Part D deductible does not apply to ACIP-recommended vaccines.

7. Thinking vaccines count toward the $2,000 OOP cap. They don't (no OOP spent at $0 cost-sharing).

8. Not realizing same-day multi-vaccine administration is safe and covered. Multiple vaccines can be given at the same visit.

9. Confusing all travel vaccines. Some travel vaccines are ACIP-recommended and $0; others may require payment.

10. Believing Medicare Advantage MA plans can charge for vaccines. They cannot under federal law.

11. Not knowing prior authorization is prohibited. Plans cannot require pre-approval for ACIP-recommended vaccines.

12. Missing the Tdap 10-year booster. Adults frequently forget this.

13. Thinking HPV is only for younger adults. ACIP recommends through age 26 routinely, age 27-45 with shared decision-making.

14. Not realizing pharmacy administration fees are bundled. Beneficiary pays $0 regardless of administration fee.

15. Believing vaccines need a special pharmacy. Any in-network Part D pharmacy that administers vaccines can provide ACIP-recommended vaccines at $0.

Quick reference: Georgia Medicare vaccines and cost

::: table caption="Georgia Medicare vaccines: Part B vs Part D cost-sharing"

::: callout type="key-takeaways" Key takeaways

• The $0 cost-sharing for ACIP-recommended adult vaccines was created by Inflation Reduction Act 2022 Section 11401, codified at Section 1860D-2(b)(3)(D) and Section 1860D-2(b)(8)(B) of the Social Security Act. It took effect January 1, 2023, for Part D vaccines.
• Part B vaccines (influenza, pneumococcal, hep B high-risk, COVID-19) have been $0 since the Affordable Care Act of 2010.
• Part D ACIP-recommended adult vaccines now $0: Shingrix, Tdap, MMR adult catch-up, HPV, RSV, hepatitis A, meningococcal, and others on the ACIP adult schedule.
• The Part D annual deductible is waived for these vaccines under Section 1860D-2(b)(8)(B). Cost is $0 from January 1 each year.
• Prior authorization and step therapy are prohibited for ACIP-recommended vaccines under IRA.
• Georgia beneficiaries can get vaccinated at any in-network pharmacy (CVS, Walgreens, Walmart, Kroger, Publix, others) or participating physician office; both pathways are $0.
• Same-day multiple vaccinations are generally safe and covered (e.g., flu + COVID + Shingrix at one visit).
• GeorgiaCares (1-866-552-4464) provides free counseling on Medicare vaccine coverage. :::

::: accordion title="Frequently Asked Questions"

What is the $0 cost-sharing for Medicare vaccines?

The Inflation Reduction Act 2022 Section 11401 eliminated all beneficiary cost-sharing on ACIP-recommended adult vaccines covered under Medicare Part D effective January 1, 2023. Beneficiaries pay $0 with no deductible, no coinsurance, and no copayment. Part B vaccines (influenza, pneumococcal, hep B high-risk, COVID-19) have been $0 since the Affordable Care Act 2010.

Which vaccines are covered under Medicare Part B at $0?

Influenza (annual), pneumococcal (PPSV23, PCV15, PCV20), hepatitis B for high-risk adults, and COVID-19. Part B vaccines have been $0 cost-sharing for years.

Which vaccines are covered under Medicare Part D at $0?

ACIP-recommended adult vaccines including Shingrix (shingles), Tdap, Td, adult MMR catch-up, HPV (Gardasil 9), RSV (Arexvy, Abrysvo, mRESVIA), hepatitis A, meningococcal (MenACWY, MenB), and others on the ACIP adult immunization schedule.

What is ACIP?

ACIP is the Advisory Committee on Immunization Practices, a federal advisory committee at the CDC. ACIP develops recommendations for vaccine use in the United States, which are then incorporated into the US adult immunization schedule. The IRA $0 cost-sharing applies to ACIP-recommended adult vaccines.

What is Shingrix and why is it important?

Shingrix is the FDA-approved zoster vaccine recombinant for shingles prevention. ACIP recommends a 2-dose series for adults 50 and older. Pre-IRA, the two-dose series required significant out-of-pocket cost. Post-IRA, it is $0.

What are the RSV vaccines?

RSV (respiratory syncytial virus) vaccines for adults were approved by the FDA. Arexvy (GSK), Abrysvo (Pfizer), and mRESVIA (Moderna) are available. ACIP recommends single-dose vaccination for adults 60+, with a universal recommendation for adults 75+ and a risk-based recommendation for adults 60–74 with high-risk conditions. All are $0 cost-sharing.

Can I get vaccinated at a pharmacy in Georgia?

Yes. Georgia pharmacies (CVS, Walgreens, Walmart, Kroger, Publix, Rite Aid, independent pharmacies) administer adult vaccines under collaborative practice agreements and pharmacist standing orders. The cost to beneficiary is $0. Walk-in or appointment.

Can I get vaccinated at my physician's office?

Yes. Physician offices administer vaccines as part of office visits. Cost to beneficiary is $0. Some offices prefer to refer patients to pharmacies for Part D vaccines because of billing simplicity.

Can I get multiple vaccines at one visit?

Generally yes. Multiple vaccines can be given at the same visit safely (e.g., flu + COVID + Shingrix). Discuss with your provider, particularly if you have weakened immune system.

Do I have to satisfy the Part D deductible first?

No. The Inflation Reduction Act waived the Part D annual deductible for ACIP-recommended vaccines under Section 1860D-2(b)(8)(B). You pay $0 from January 1, not the standard Part D deductible plus vaccine cost.

Does my plan have to cover ACIP-recommended vaccines?

Plans must comply with IRA Section 11401. ACIP-recommended adult vaccines covered under Part D must be at $0 cost-sharing. Plans cannot impose prior authorization or step therapy on these vaccines.

What if my plan doesn't have my vaccine on formulary?

Most plans cover all major ACIP-recommended adult vaccines. If your specific vaccine isn't on formulary, request a coverage exception under Section 1860D-4(g). Anti-discrimination provisions prevent plans from excluding ACIP-recommended vaccines without medical justification.

Does the $0 cost-sharing count toward the $2,000 OOP cap?

No. Since you pay $0, there is no OOP to count. The $2,000 cap protects against accumulation from other drugs (insulin, anticoagulants, biologics).

What about Medicare Advantage MA-PD plans?

MA-PD plans are subject to the same $0 cost-sharing requirement. MA plans cannot impose copayments on ACIP-recommended vaccines.

What about Low Income Subsidy (LIS) recipients?

LIS recipients also pay $0 under IRA Section 11401. Pre-IRA, LIS recipients paid minimal copayments. Now they pay $0 like everyone else.

What if I get vaccinated out-of-network?

Generally, out-of-network vaccine administration is not covered. The $0 cost-sharing applies to in-network providers. Verify with your plan before traveling or using non-network providers.

What about travel vaccines?

Some travel vaccines are ACIP-recommended and $0 (e.g., hepatitis A for travelers, certain meningococcal indications). Travel vaccines not ACIP-recommended for the general adult population may have cost-sharing. Consult your provider before international travel.

Is HPV vaccine covered for older adults?

ACIP recommends HPV vaccination through age 26 routinely and shared decision-making for adults age 27-45. When ACIP-recommended, HPV is $0 under IRA Section 11401.

What is the difference between Part B and Part D vaccines?

Part B covers preventive vaccines determined by statute (influenza, pneumococcal, hep B high-risk, COVID-19). Part D covers most other ACIP-recommended adult vaccines (Shingrix, Tdap, MMR, HPV, RSV, hepatitis A, meningococcal).

Why was vaccine cost-sharing reformed by the IRA?

Federal data and patient surveys showed substantial vaccine cost barriers for Medicare Part D beneficiaries. Shingrix uptake was significantly lower among Medicare-aged adults than under commercial insurance due to the out-of-pocket cost burden. The IRA addressed this gap to improve public health.

Are there any vaccines that still have cost-sharing under Part D?

Non-ACIP-recommended vaccines may have cost-sharing. Vaccines for travel beyond ACIP recommendations may have cost-sharing. Out-of-network administration is not subject to $0 cost-sharing.

Can pharmacy administration fees be charged to me?

No. The administration fee is bundled into the plan or Medicare reimbursement; the beneficiary pays $0 total for the vaccine and administration.

Where can I find the current ACIP adult vaccine schedule?

The CDC website at cdc.gov/vaccines/schedules/hcp/imz/adult.html publishes the current adult immunization schedule, updated annually based on ACIP recommendations.

Where can I get help with Medicare vaccine coverage questions in Georgia?

GeorgiaCares (1-866-552-4464) provides free Medicare counseling. Georgia Department of Public Health Immunization (404-657-3158) provides vaccine information. Medicare (1-800-MEDICARE) handles plan-specific questions. CDC Vaccine Information (1-800-CDC-INFO) provides general vaccine information. :::

::: cta Georgia Medicare Vaccines Resources

Free help understanding Medicare vaccine coverage, the Inflation Reduction Act Section 11401 framework, and your Part B and Part D vaccine options is available from these Georgia and federal organizations.

• GeorgiaCares (Georgia SHIP): 1-866-552-4464 : free one-on-one Medicare counseling on vaccine coverage
• Medicare: 1-800-MEDICARE (1-800-633-4227) : Part B and Part D vaccine questions
• Social Security Administration: 1-800-772-1213 : Low Income Subsidy applications
• Georgia Department of Public Health Immunization Section: 404-657-3158 : Georgia immunization resources
• CDC Vaccine Information: 1-800-CDC-INFO (1-800-232-4636) : vaccine science and recommendations
• Georgia Department of Community Health Medicaid Member Services: 1-866-211-0950 : Medicaid coordination
• Georgia Office of Insurance Commissioner: 1-800-656-2298 : plan complaints
• AARP Georgia: 1-866-295-7283 : senior advocacy
• Medicare Rights Center: 1-800-333-4114 : national helpline for Medicare appeals
• Center for Medicare Advocacy: 1-860-456-7790 : legal assistance for Medicare disputes
• Justice in Aging: 202-289-6976 : national legal advocacy for low-income seniors
• Medicare Beneficiary Ombudsman: assistance with unresolved Medicare complaints
• 211 Georgia: dial 211 : referrals to local senior assistance
• Eldercare Locator: 1-800-677-1116 : connects to local Georgia Area Agencies on Aging
• Atlanta Legal Aid Senior Citizens Law Project: 404-377-0701
• Palmetto GBA Georgia MAC: 1-855-696-0705 : Georgia Medicare Administrative Contractor
• CMS Region IV Office (Atlanta): regional CMS office for Georgia
• Brevy: brevy.com : comprehensive eldercare guides including Medicare Part D, the $2,000 OOP cap, vaccines coverage, and the Medicare Drug Price Negotiation Program for Georgia families :::

Disclaimer: This guide is for informational purposes only and does not constitute legal, financial, medical, or insurance advice. Medicare vaccine coverage rules, ACIP recommendations, and plan-specific formularies change annually. Federal authorities cited include Section 11401 of the Inflation Reduction Act 2022 (Public Law 117-169), Section 1860D-2(b)(3)(D) and Section 1860D-2(b)(8)(B) of the Social Security Act, Section 1861(s)(10) of the Social Security Act, and CMS guidance current as of May 2026. ACIP recommendations are published in the CDC Morbidity and Mortality Weekly Report (MMWR). For your specific situation, consult your physician, contact GeorgiaCares (1-866-552-4464) for free counseling, or call Medicare (1-800-MEDICARE) directly.

Find personalized help navigating Medicare vaccine coverage at brevy.com.