Tricare Help

If Medicare won’t cover vaccine, will Tricare step in?

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I am a 77-year-old retiree covered by Tricare for Life. My civilian doctor recently said I needed a combination shot for tetanus, pertussis and whooping cough, although he said Medicare may not cover it. If Medicare rejects that bill, will Tricare for Life pay it?

As you’ve discovered, Medicare is a bit finicky about which immunizations it will cover for senior citizens. The only preventive vaccines routinely covered are for flu, pneumonia and hepatitis B. Medicare covers other vaccines only if you are actually exposed to the virus or disease that the vaccine is meant to deter. For example, if you step on a rusty nail, Medicare will cover a tetanus shot.

For Tricare for Life beneficiaries, Medicare acts as first payer and Tricare Standard acts as a backup second payer to cover things Medicare does not. This doesn’t mean Tricare will cover every conceivable medical procedure or service, but it generally will cover anything that is deemed “medically necessary” by a health care provider. That includes coverage of age-appropriate doses of vaccines.

To find out if this specific immunization would be covered, you should contact the Tricare managed-care contractor for the Tricare region in which you live.