With the approaching flu season and ongoing pandemic it’s important to encourage Mercy Care Advantage (MCA) members to get their flu shot earlier this year to assist in prevention.
Under our Medicare contract, MCA must provide coverage for immunizations covered under Medicare Part B and Medicare Part D. Medicare Part B covered immunizations include:
- Pneumonia vaccine
- Flu shots, once each flu season, with additional flu shots when medically necessary
- Hepatitis B vaccine if the member is at high or intermediate risk of getting Hepatitis B
- Other vaccines if the member is at risk and meets Medicare Part B coverage criteria rules
The Flu, Pneumonia, and Hepatitis B vaccines are covered for a $0 copay.
Network providers are expected to administer covered vaccines to MCA members when the member meets coverage criteria. Mercy Care Advantage members can also access the Flu, Pneumonia, and Hepatitis B vaccines from participating retail pharmacies though a vaccine program Mercy Care has established with CVS Health.
In addition to the common vaccines mentioned above, additional vaccines are covered under Medicare Part D and can be obtained from participating pharmacies that carry and can administer. Examples include:
- Hepatitis A
- Shingles
- Meningococcal
- Measles
- Mumps
- Rubella (MMR)
- Tdap (Tetanus, Diphtheria, Pertussis)
The member’s applicable Part D copay will apply to the vaccines above.
The MCA Evidence of Coverage, Chapter 4 Benefits Chart, under the section titled “Immunizations” explains which vaccines are covered under Medicare Part B. The MCA Formulary includes the vaccines covered under Medicare Part D. These plan materials are available on our website at www.mercycareaz.org.
As always, don't hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website.
Thanks for all you do!
