Utah · Medicare · Vaccine coverage for the 2026–27 respiratory season

Medicare Vaccines in Utah (2026): Shingles, Flu, RSV, COVID

Every adult vaccine the CDC recommends is covered by Medicare at $0, but four are paid by Part B and the rest by Part D, and that split decides where you should get the shot and whether you are covered at all. Here are the rules in Medicare's own words, plus CMS claims data on how many Utahns on Medicare actually rolled up a sleeve.

Utah Retirement Income Data Desk

Reviewed by Brian Penner, Retirement income & long-term care planner · Published September 26, 2026

Yes, Medicare covers vaccines, and in 2026 it covers every adult vaccine the CDC recommends with no copayment and no deductible. What trips people up is not whether a shot is covered but which part of Medicare covers it. Medicare.gov's preventive services page lists exactly four vaccines under Part B: COVID-19, flu, hepatitis B and pneumococcal. Everything else, including the shingles vaccine that pharmacies advertise every fall and the RSV vaccine that Medicare.gov says adults 75 and older should ask about, is covered through Medicare drug coverage, Part D, or the drug benefit inside a Medicare Advantage plan. If you have Part D, the shingles vaccine costs you nothing. If you do not, it is not covered at all. The rest of this article walks through the four Part B vaccines, the Part D rule that took effect on January 1, 2023, where to get each shot so the bill goes to the right place, and what CMS's claims files say about how many Utahns on Medicare got vaccinated in 2024.

Which vaccines does Medicare Part B cover at $0?

Medicare.gov's page on preventive and screening services names four vaccines under Part B, and each has its own page with the same cost sentence: you pay nothing if your doctor or other health care provider accepts assignment for giving the vaccine.

• Flu. “Medicare Part B (Medical Insurance) covers the seasonal flu vaccine,” usually once each flu season. For the 2026–27 season Medicare.gov says you can get a trivalent flu vaccine that protects against three flu viruses, and that “people 65 and older can get a trivalent flu vaccine to lower the risk of hospital visits and death.” You can get it at your doctor's office or your local pharmacy.
• COVID-19. Part B covers FDA-approved and FDA-authorized COVID-19 vaccines for anyone who has Medicare. Medicare.gov lists the updated Moderna, Pfizer-BioNTech and Novavax formulas and says to bring your red, white and blue Medicare card so the provider or pharmacy can bill Medicare.
• Pneumococcal. Part B covers pneumococcal vaccines, which protect against the bacteria that cause pneumonia; Medicare.gov says to talk with your provider about which vaccines are right for you. In Utah in 2024, 11,108 Original Medicare beneficiaries received the 20-valent conjugate vaccine (billing code 90677), 283 the newer 21-valent vaccine (90684) and 463 the older 23-valent polysaccharide vaccine (90732). The Medicare-approved amount for the vaccine itself ran $278.93 to $317.90 a dose for the conjugate vaccines, all of it paid by Medicare.
• Hepatitis B. Part B covers the hepatitis B vaccine if you have never completed the series, do not know your vaccination history, or have a condition that puts you at medium or high risk, such as diabetes or end-stage renal disease. Only 342 Utahns had one billed to Part B in 2024.

One Part B wrinkle is worth knowing. A tetanus-diphtheria-pertussis (Tdap) shot is a Part D vaccine when it is a routine booster, but Part B pays for it when it is part of treating an injury, and then ordinary Part B cost-sharing applies. The 2024 CMS file shows it: for the 238 Utahns whose Tdap was billed to Part B, the average Medicare-approved amount was $37.64 and Medicare paid an average of $26.36, leaving about $11.28 to the patient or a Medigap policy. The same booster given routinely at a pharmacy and billed to Part D is $0.

Which vaccines does Part D cover at $0, and since when?

Medicare.gov's shingles page puts the rule in two sentences: “You pay nothing for the shingles vaccine if you have Part D. Part D covers all adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) that aren't covered under Medicare Part B (Medical Insurance), including the vaccines for Respiratory Syncytial Virus (RSV), whooping cough, measles, and more.” Then the part that changed: “Your Part D plan won't charge you a copayment or apply a deductible for vaccines ACIP recommends.” The same wording appears on the RSV and Tdap pages.

That is a recent rule. Before 2023, Part D vaccines went through your plan's deductible and tiers like any other prescription, and a two-dose Shingrix series could cost several hundred dollars out of pocket. CMS explains that beginning on January 1, 2023, the Inflation Reduction Act eliminated cost-sharing for all adult vaccines covered under Part D that are recommended by ACIP, and reports that more than 10 million people with Part D received a covered vaccine in 2023, up from 3.4 million in 2021. The 2026 Part D deductible can be as high as $615, and CMS has set the 2027 figure at $700, but neither applies to a recommended vaccine. Nor does the $2,100 out-of-pocket cap come into play; there is nothing to count toward it.

The Part D vaccines an older adult is most likely to be offered:

• Shingles (Shingrix), a two-dose series. Medicare.gov: covered by Part D, you pay nothing if you have Part D.
• RSV (Arexvy, Abrysvo, mResvia). Medicare.gov: “Adults 75 and older, and adults between 50–74 with certain conditions, are at high risk of having serious health complications from RSV,” and Part D covers the vaccine at $0. Medicare Advantage plans that include drug coverage cover it too.
• Tdap (tetanus, diphtheria, whooping cough), the routine booster. Medicare.gov: covered by Part D, you pay nothing.
• Other ACIP-recommended adult vaccines such as measles-mumps-rubella and hepatitis A, when your provider recommends them.

Which part of Medicare pays for each vaccine?

Sources: Medicare.gov, “Preventive & screening services” — medicare.gov; “Flu vaccines” — medicare.gov; “COVID-19 vaccine” — medicare.gov; “Pneumococcal vaccines” — medicare.gov; “Hepatitis B vaccines” — medicare.gov; “Shingles vaccines” — medicare.gov; “RSV shot” — medicare.gov; “Tdap vaccines” — medicare.gov. Age guidance for the shingles vaccine and the Tdap interval are the CDC's general adult schedule; your provider decides what is appropriate for you.

Where should you get each shot so the bill goes to the right place?

The Part B and Part D split is an administrative fact that becomes a practical one at the counter. A pharmacy can bill Part B for a flu, COVID-19 or pneumococcal vaccine and bill your Part D plan for a shingles or RSV vaccine in the same visit, because pharmacies are built to submit drug-plan claims. Many doctors' offices are set up to bill Part B but not Part D. If a clinic gives you a Shingrix dose it cannot bill to your plan, it may ask you to pay the full price and submit the receipt to your Part D plan for reimbursement, and the reimbursement is limited to what the plan would have paid its own network pharmacy. So before a Part D vaccine at a doctor's office, ask one question: can you bill my Part D plan directly? If the answer is no, take the prescription to a network pharmacy. Bring both cards: your Medicare card (or Medicare Advantage card) for the Part B shots and your Part D card for the rest.

Two other things to check. First, that the pharmacy is in your Part D plan's network; the $0 vaccine benefit applies at network pharmacies, and an out-of-network fill may not be covered. Second, that any doctor or clinic giving a Part B vaccine accepts assignment, which nearly all do for vaccines. Utah's yearly “Wellness” visit is a good moment to sort this out, since the written prevention plan it produces lists the vaccines you are due for; our guide to the Annual Wellness Visit versus a physical explains what that visit does and does not include.

How many Utahns on Medicare actually get these shots?

CMS publishes two files that answer this from claims rather than surveys. The first counts every service billed to Original Medicare Part B by billing code and by the state of the provider who delivered it. For calendar year 2024, the most recent year released, Utah doctors, clinics and pharmacies billed Part B for giving a flu vaccine to 72,258 beneficiaries. Measured against the 183,494 Utahns with Part B in Original Medicare that year, that is 39.4%, against 40.7% nationally. COVID-19 vaccines reached 48,353 Utahns (26.4% vs. 26.1%) and pneumococcal vaccines 11,794 (6.4% vs. 6.1%). These figures cover only people in Original Medicare and only vaccines billed as professional claims, so they undercount the true vaccination rate; their value is the comparison, and on the Part B vaccines Utah tracks the country closely.

Sources: CMS, Medicare Physician & Other Practitioners — by Geography and Service, calendar year 2024, Utah and National rows — data.cms.gov; CMS, Medicare Part D Prescribers — by Geography and Drug, 2023 and 2024 — data.cms.gov; CMS, Medicare Monthly Enrollment — data.cms.gov.

Administration codes count the act of giving the vaccine, so each row is one beneficiary per vaccine type regardless of which product was used. Denominator is people with Part B in Original Medicare during 2024 (Utah 183,494; national 27,982,142). Geography is the state of the rendering provider; Medicare Advantage encounters and hospital outpatient claims are excluded. Source: CMS, Medicare Physician & Other Practitioners by Geography and Service, 2024.

The flu rows carry a second finding. Of the 70,227 flu vaccine products billed to Part B by Utah providers in 2024, 66,216, or 94.3%, were the high-dose vaccine (billing code 90662, 49,202 Utahns) or one of the adjuvanted vaccines, the formulations developed for adults 65 and older, against 91.9% nationally. That matches the CDC's guidance: it and ACIP preferentially recommend the higher-dose or adjuvanted flu vaccines over standard-dose unadjuvanted vaccines for people 65 and older, and say to take a standard-dose vaccine if none of those is available rather than wait. Medicare paid an average of $79.82 for each high-dose vaccine in Utah on top of the $24.88 administration fee, and the beneficiary paid nothing. If a pharmacy offers you a choice, the “senior” formulation is covered the same way as the standard one.

What do the Part D files show for shingles and RSV vaccines in Utah?

The second CMS file lists every drug filled under Part D by state, with the number of people who filled it. Because ACIP-recommended vaccines have carried no cost-sharing since January 1, 2023, this is also a record of what the benefit is worth. In 2024, 19,012 Utahns filled 24,836 Shingrix claims, written by 778 Utah prescribers, at a total drug cost of $4,714,275, about $189.82 a dose. The file's two beneficiary cost-sharing fields for those claims both read $0. Add the three RSV vaccines and Utah's Part D plans and Medicare paid about $11,327,395 for these four vaccines in 2024, with total beneficiary cost-sharing recorded at $239.80 across all of them.

The year-over-year pattern is a first-season surge and then a settling. Shingrix reached 26,256 Utahns in 2023, the first year of $0 cost-sharing, and 19,012 in 2024; the RSV vaccines, which became available in 2023, reached 38,221 Utahns that first season and 24,388 the next. The same shape appears nationally. Measured against Part D enrollment, Utah ran slightly below the national rate in both years: 5.18% of Utah Part D enrollees got a Shingrix dose in 2024 against 5.39% nationally, and 6.65% got an RSV vaccine against 8.23%.

Beneficiaries are people with at least one claim for the drug during the year; a person who completed both Shingrix doses in the same year is counted once but generates two claims. Drug cost is the total paid by the plan, Medicare and the enrollee combined. mResvia was not on the market in 2023. Denominators are Part D enrollment from CMS Medicare Monthly Enrollment (Utah 340,089 in 2023 and 366,921 in 2024; national 51,903,545 and 54,375,198). Geography is the state of the prescriber. Source: CMS, Medicare Part D Prescribers by Geography and Drug, 2023 and 2024.

Are Utah seniors vaccinated more or less than the rest of the country?

Claims count shots billed in a year; surveys ask people whether they have ever been vaccinated, which is the better measure for a one-time or once-a-decade vaccine. The CDC's Behavioral Risk Factor Surveillance System does that, and its most recent Utah estimates for adults 65 and older sit above the national figures for the shingles vaccine, the pneumococcal vaccine and Tdap. Flu is the exception. Utah's estimated flu vaccination rate among adults 65 and older was 60.1% for the 2024–25 season, against 63.8% nationally, and it has fallen every season but one since 2020–21, when it was 75.6%.

Estimated share of adults 65 and older who received a flu vaccine, by season, measured at the end of the season (May); Utah bars solid, national bars lighter. Source: CDC, Influenza Vaccination Coverage for All Ages (6+ Months), BRFSS — data.cdc.gov. Survey estimates carry confidence intervals of roughly plus or minus 3 points for Utah.

Source: CDC, Vaccination Coverage among Adults (18+ Years), BRFSS, “Overall” rows for Utah and the United States, most recent year published for each vaccine — data.cdc.gov; flu row from the dataset cited above. These estimates cover all adults 65 and older, not only those on Medicare.

How does this work with Medicare Advantage or a Medigap policy?

More than half of Utah's Medicare population, 269,226 of 490,235 people in June 2026, is in a Medicare Advantage plan. A Medicare Advantage plan must cover everything Part B covers, including the four Part B vaccines, and Medicare.gov's RSV page says that Medicare Advantage plans that include drug coverage also cover the Part D vaccines. The practical difference is the network: use a pharmacy or provider in your plan's network, and if your plan requires it, one in its drug-plan network for the Part D vaccines. None of the Medicare Advantage vaccinations appear in the Part B claims figures above, which is one reason those figures undercount.

If you are in Original Medicare with a Medigap policy, the four Part B vaccines are $0 anywhere in the country from a provider who accepts assignment, and the Medigap policy has nothing to pay. The catch is the other list. Medigap policies do not include drug coverage, so the shingles, RSV and Tdap vaccines are covered only if you also have a stand-alone Part D plan. In June 2026, 140,879 Utahns had a stand-alone drug plan and 251,606 had drug coverage through a Medicare Advantage plan; the roughly 97,750 without either would pay the full price of a Part D vaccine themselves. That is also a reason not to skip Part D on the theory that you take no medications: beyond the late enrollment penalty, the vaccine benefit alone can be worth several hundred dollars in a year when you are due for Shingrix and RSV. If your income is limited, Extra Help can cover most or all of a Part D premium.

A St. George example: a fall of four shots

Consider a 72-year-old man in Washington County in Original Medicare with a Plan G Medigap policy and a stand-alone Part D plan. At his Wellness visit in September his clinic's checklist shows he is due for a flu vaccine, the updated COVID-19 vaccine, the two-dose shingles series he has been putting off, and, because he has heart disease, an RSV vaccine. The clinic gives him the high-dose flu vaccine and the COVID-19 vaccine on the spot and bills Part B; his statement shows Medicare paid about $79.82 for the flu vaccine plus the administration fee, and $0 due from him. When he asks about Shingrix, the front desk tells him they cannot bill his drug plan, so he takes the prescriptions to a network pharmacy in St. George, shows his Part D card, and gets the first Shingrix dose and the RSV vaccine the same afternoon at $0, with the second Shingrix dose scheduled for December.

Had he let his Part D plan lapse, the pharmacy would have charged him the full price. At the 2024 Utah average cost per claim of $189.82 for Shingrix and $260.58 to $280.82 for an RSV vaccine, the two-dose shingles series plus the RSV vaccine comes to roughly $640, money a Part D plan would otherwise have paid in full. The four Part B shots would have been $0 either way.

Why a fall of vaccines belongs in a retirement plan

The illnesses these vaccines prevent are the same ones that turn a good retirement year into an expensive one. Pneumonia, flu and RSV are among the most common reasons an older adult is admitted to a hospital, and a hospital stay is often the doorway to the skilled nursing, home health and long-term care costs that this site spends most of its time on. Shingles rarely kills, but the nerve pain that can follow it lasts for months and is a common reason people stop driving, cooking and living independently for a stretch. A plan that already has the income, the coverage and the paperwork in place for a health setback is better; a plan that lowers the odds of the setback is better still, and this part of it costs nothing. If you are reviewing coverage during this year's Annual Enrollment Period, make sure whatever you choose includes drug coverage, and use the vaccine checklist from your Wellness visit as the first thing you do with it.

Frequently asked questions

Sources

• Medicare.gov — Preventive & screening services (the four Part B vaccines; “you pay nothing for most preventive services” with assignment): medicare.gov — preventive services
• Medicare.gov — Flu vaccines (Part B; once each season; trivalent vaccine for 2026–27; people 65 and older): medicare.gov — flu vaccines; COVID-19 vaccine (Part B; updated Moderna, Pfizer-BioNTech and Novavax formulas): medicare.gov — COVID-19 vaccine; Pneumococcal vaccines: medicare.gov — pneumococcal; Hepatitis B vaccines (eligibility conditions): medicare.gov — hepatitis B
• Medicare.gov — Shingles vaccines (Part D; $0; no copayment or deductible for ACIP-recommended vaccines): medicare.gov — shingles vaccines; Respiratory Syncytial Virus (RSV) shot (Part D; adults 75+ and 50–74 with certain conditions at high risk): medicare.gov — RSV shot; Tdap vaccines: medicare.gov — Tdap
• CDC — Flu and People 65 Years and Older (preferential recommendation for higher-dose or adjuvanted flu vaccines in this age group): cdc.gov — flu and people 65 and older
• CMS — press release, May 3, 2024 (Inflation Reduction Act eliminated cost-sharing for ACIP-recommended adult vaccines under Part D beginning January 1, 2023; more than 10 million Part D enrollees received a covered vaccine in 2023 vs. 3.4 million in 2021): cms.gov — Part D vaccine data
• Medicare.gov — Costs for Medicare drug coverage (2026 Part D deductible up to $615; $2,100 out-of-pocket cap): medicare.gov — Part D costs; CMS — CY 2027 Rate Announcement, Attachment V (2027 Part D deductible $700): cms.gov — 2027 announcement (PDF)
• CMS — 2026 Medicare Parts A & B Premiums and Deductibles, November 14, 2025 (Part B premium $202.90; Part B deductible $283): cms.gov — 2026 premiums and deductibles
• CMS — Medicare Physician & Other Practitioners — by Geography and Service, calendar year 2024 (Utah: 72,258 flu, 48,353 COVID-19, 11,794 pneumococcal and 342 hepatitis B vaccine administrations; flu and pneumococcal product counts and allowed amounts; Tdap under Part B): data.cms.gov — physician & other practitioners by geography and service
• CMS — Medicare Part D Prescribers — by Geography and Drug, calendar years 2023 and 2024 (Utah: Shingrix 26,256 and 19,012 beneficiaries; Arexvy, Abrysvo and mResvia as tabulated; drug cost and beneficiary cost-sharing fields): data.cms.gov — Part D prescribers by geography and drug
• CMS — Medicare Monthly Enrollment (2024: 183,494 Utahns and 27,982,142 nationally with Part B in Original Medicare; Part D enrollment 340,089 and 366,921 in Utah; June 2026: 490,235 Utah beneficiaries, 269,226 in Medicare Advantage, 140,879 in stand-alone drug plans and 251,606 in Medicare Advantage drug plans): data.cms.gov — monthly enrollment
• CDC — Vaccination Coverage among Adults (18+ Years), BRFSS (Utah and U.S. adults 65+: shingles 2023, pneumococcal 2024, Tdap and Td/Tdap 2022): data.cdc.gov — adult vaccination coverage; Influenza Vaccination Coverage for All Ages (6+ Months) (adults 65+, seasons 2020–21 through 2024–25): data.cdc.gov — flu vaccination coverage
• Utah Insurance Department — Medicare consumer page (Utah SHIP (877) 424-4640): insurance.utah.gov

About this article. Written by the Utah Retirement Income Data Desk and reviewed by Brian Penner, Retirement income & long-term care planner. Educational only — not medical, financial, or legal advice, and not a recommendation of any specific plan, provider, vaccine or treatment; whether and when to receive a vaccine is a decision for you and your health care provider. Coverage rules and cost-sharing are quoted from Medicare.gov and CMS as of September 26, 2026; the Utah and national beneficiary counts, shares and average amounts are our own tabulation of the CMS Physician & Other Practitioners, Part D Prescribers and Medicare Monthly Enrollment public use files, which count Original Medicare or Part D claims only and which CMS revises periodically; the vaccination coverage figures are CDC survey estimates for all adults 65 and older with sampling error. Average costs per claim are averages across all claims and are not price quotes; the example household is illustrative. What you will owe depends on your coverage, your provider or pharmacy and whether it accepts assignment or is in your plan's network; confirm with your plan, your provider, or 1-800-MEDICARE before you act. Utah Retirement Income is a licensed independent insurance agency (NPN 16493717) and is not a government agency; we are not connected with or endorsed by Medicare, the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, the Social Security Administration, or any government program, and nothing here should be read as an endorsement by them. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area; please contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Assistance Program — in Utah, the Utah SHIP at (877) 424-4640 — to get information on all of your options. A $0-premium Medicare Advantage plan is not free; you still pay the Part B premium ($202.90 a month in 2026 for most people) and the plan's cost-sharing for services other than covered preventive vaccines. Long-term care insurance and annuity guarantees depend on the claims-paying ability of the issuing company, with no promise of savings. If you call or text us, you consent to be contacted at the number you provide about your options; message and data rates may apply, and you can opt out at any time by replying STOP.