Does Medicare Cover Meningitis Prevention and Treatment?

Written by:

Kayla Missman

Reviewed by:

Amy Albert

4 min read

Key Takeaways

Original Medicare covers meningitis treatment but not preventive vaccines.
Medicare Part D and Advantage plans cover vaccines at no cost if recommended.
Meningitis is a serious bacterial infection with high risks for infants, teens, older adults, and people with certain conditions like HIV or asplenia.
The meningococcal vaccine effectively prevents meningitis, with CDC-recommended doses for at-risk groups. Boosters may be needed.

Original Medicare does not cover meningitis prevention but will cover treatment if you contract the disease. If you’re at higher risk for meningitis, taking proactive steps — like getting the meningitis vaccine (also called the meningococcal vaccine) — is essential.

While Original Medicare will not pay for the vaccine, Medicare Part D, a stand-alone drug plan, covers most vaccines, including this one. Medicare Advantage plans may also provide coverage for meningitis prevention. In this article, we’ll break down what meningitis is, who should get vaccinated, and how to ensure your vaccine is covered.

Additional Benefits Fulfill Coverage Needs

Meningitis is an invasive bacterial infection of the brain and spinal cord that can develop quickly. About 1 in 5 people who develop meningitis have long-term complications, and the mortality rate is about 15%. Meningitis requires immediate treatment with antibiotics.

Although meningococcal meningitis rates have risen since 2013, it’s still relatively uncommon in the U.S., with 438 cases reported in 2023. However, certain age groups are more at risk of contracting meningitis: infants, 16- to 23-year-olds, and adults over 65. People on certain medications or with compounding health conditions, such as asplenia or HIV, also face increased risk.

Medicare covers older adults and younger people with health conditions, both groups that could be vulnerable to meningitis or long-term complications. Thankfully, vaccines are effective prevention. The CDC recommends vaccines or boosters for at-risk people, and Medicare beneficiaries with Part D or Medicare Advantage can get their shots for free.

How the Meningococcal Vaccine Works

The meningococcal vaccine helps prevent meningitis and blood infections. It introduces a small amount of dead or weakened meningococcal bacteria, triggering the body to produce antibodies. If the person is exposed to the bacteria again, their immune system can fight it more effectively because it already has the necessary antibodies.

The CDC recommends vaccinating all children at 11 years old and with a booster at 16. After that, people generally do not need to be vaccinated again unless they fall into an at-risk category. If you’re at risk, your doctor may recommend getting vaccinated. You typically need two to three initial doses, with boosters every few years as required.

How Medicare Covers Meningitis Treatment

While Original Medicare does not cover any meningococcal vaccines, it does cover the treatment of meningococcal diseases, including meningitis. Meningitis must be treated right away, and it requires a hospital stay. If you exhibit meningitis symptoms, you’ll be immediately treated with antibiotics while the provider runs a blood test to confirm your diagnosis.

Medicare Part A covers hospital expenses, including your room, antibiotics, and diagnostic tests. However, remember that you must meet your Part A deductible before Medicare starts to pay, which is $1,676 per benefit period in 2025.

Medicare Advantage Coverage For Meningitis

If you have Medicare Advantage, your coverage may look different. Private insurance companies sell Medicare Advantage plans and can set costs and coverages. However, all Medicare Advantage plans must provide the same benefits as Original Medicare at minimum, including hospital stays and meningitis treatment. This means all Medicare Advantage plans will cover at least the same things as Original Medicare when it comes to meningitis treatment.

Medicare Advantage coverage varies by plan, insurance company, and region. However, many plans feature additional benefits. For example, many Medicare Advantage plans bundle in Part D, offering the benefits of Original Medicare plus prescription drug coverage. Since Part D covers most vaccines, a bundled Medicare Advantage plan will cover meningococcal vaccines. There may be network requirements for where you get the shot.

Medicare Part D Coverage for Meningitis

If you have Original Medicare and want prescription drug coverage, you must purchase a separate Part D plan from a private insurance company. If you have Medicare Advantage, your plan may already include Part D coverage.

Part D covers prescription drugs and vaccines that prevent illness and injury, including meningococcal vaccines. As of January 2023, all vaccines recommended by the CDC must be provided for free under Part D. If your doctor recommends you receive a meningococcal vaccine, you are covered.

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How Much Meningitis Vaccines Cost With Medicare

Without insurance, a meningitis vaccine could cost between $110 and $190. If you only have Original Medicare and haven’t purchased a Part D plan, you will pay for the vaccine entirely out of pocket because the vaccine is not covered by Part A or Part B.

If you have Medicare Part D and a doctor’s recommendation, though, you will not pay anything out of pocket for a meningococcal vaccine. Your only cost is your Part D premium.

If your Part D coverage is bundled with your Medicare Advantage plan, your billing may look different. Medicare Advantage plans include the following costs:

Monthly plan premium plus Part B premium. Not all Medicare Advantage plans charge a premium, but many do. This monthly payment keeps your policy active.
Plan deductible. You typically need to meet your deductible before your insurer will start to pay. However, you’ll be covered right away for vaccines covered under Part D.
Out-of-network charges. You may have to pay more for care outside of the plan’s preferred network. This could include pharmacies that administer vaccines but are not within your plan’s preferred network.

Other Options for Getting Dental Crown Coverage

Pharmacies are the most common place to get a vaccine. However, if you don’t have Part D insurance and cannot afford to pay out of pocket, you can look for alternatives.

Federally funded health centers: Health centers provide care even if you don’t have insurance. They may also use a sliding scale to make your vaccine more affordable.
Local department of health: Your state or local health department may offer vaccines or direct you to free or low-cost options.
Clinic-run programs: Clinic programs help specific populations get the care they need. You might find a vaccine-focused clinic in your area. These sometimes operate as drive-through or mobile operations.

Putting It All Together

Meningococcal vaccines help prevent bacterial infections like meningitis. Older adults and people with certain conditions may need booster shots to lower their risk. While Original Medicare only covers treatment for meningitis, most vaccines, including meningococcal vaccines, are covered under Medicare Part D or Medicare Advantage plans. Work with a licensed insurance agent or broker to find a plan that covers preventative treatment and other benefits you need.