Many people who are considering getting the shingles vaccine wonder whether Medicare will cover it. You probably already know that Medicare covers many vaccines like those for the flu or pneumonia. Those vaccines are covered under Medicare Part B, with no copay required in most cases. So, does Medicare cover the shingles shot as well? Keep reading as we give you all the details that you need to know about Medicare and the shingles vaccine. We’ll tell you which part of Medicare may cover the vaccine and how you can get signed up for coverage.
Does Medicare Cover The Shingles Vaccine?
Original Medicare does not cover the shingles vaccine; however, Medicare Part D prescription drug plans will provide coverage for the shot. Medicare Part A, or Medicare hospital insurance, does not usually cover vaccines or preventive services of any kind. Medicare Part B does cover many different types of vaccines, although it does not cover the shingles vaccine. The shingles virus is the same virus that causes chickenpox, and this virus is known as the varicella-zoster virus. Many people had chickenpox as children, and those people are at a much higher risk for shingles. Shingles will cause a painful rash and blisters on the skin, and the risk increases with age. Even though your immune system will help to fight off the effects of the virus, it can reactivate and last anywhere from two to four weeks. There is no complete cure for shingles.
Shingles, or herpes zoster, can also cause many complications, so the Centers for Disease Control and Prevention (CDC) recommends that adults 50 and older get two doses of the shingles vaccine. One of the most common complications is postherpetic neuralgia. The vaccine for shingles is called Shingrix, or the recombinant zoster vaccine. Even though Medicare coverage does not pay for the shot, it is still a good idea to receive this vaccine — especially if you had chickenpox as a child. If you have a Medicare Advantage Plan that includes prescription drug coverage, then you can likely receive the vaccine for just the amount of your copay.
Parts Of Medicare That Cover The Shingles Vaccine
The part of Medicare that covers the vaccine is your Medicare Part D plan or the Medicare prescription drug plan. Remember that a Part D plan is optional, so you might not be enrolled in one of these plans unless you decide to sign up for coverage. Part D typically provides coverage for prescription drugs, and the shingles vaccine is one drug that most plans cover. If you are enrolled in a Medicare Advantage plan, then your plan likely includes prescription drug coverage that will cover the vaccine. Since these Advantage plans are insurance plans administered by private insurance companies, you should contact your provider if you have any specific coverage questions or need help with the details of your plan. Many people also wonder if Medicare covers eye exams. These Medicare Advantage plans often include additional benefits like dental and vision coverage.
Original Medicare will not cover the shingles vaccine. Medicare Part A, or hospital insurance, pays for hospital stays and inpatient care. Vaccines and preventive services are never covered under Medicare Part A. Medicare Part B, which is more traditional medical insurance, pays for doctor’s office visits, outpatient care, and many preventive services. Part B will cover many immunizations, like the flu vaccine, pneumonia vaccine, and hepatitis B vaccine. Unfortunately, Part B does not cover the shingles vaccine. If you are not enrolled in a Part D plan, then this vaccine will be an out-of-pocket cost for you.
Cost Of Shingrix
So, how much does the shingles vaccine cost? The answer depends on whether you are enrolled in healthcare coverage that will cover the vaccine. The Shingrix vaccine is the most popular of the available vaccines, and it is the brand-name drug. Zostavax is the other vaccine that has been approved by the FDA, and we will briefly mention its cost here as well.
— With Medicare:
The amount that you will have to pay for your vaccine depends heavily on the specifics of your Medicare Part D plan or your Part C Medicare Advantage Plan. Each plan has different rules for premiums, coinsurance payments, deductibles, and coverage. If your health insurance plan covers the vaccine, it will likely still be subject to a copay. This ranges anywhere from $10 to $25 for most plans. If you have not yet met your annual deductible, then you may be paying for the entire cost of the vaccine out of your pocket. Whether or not you receive the vaccine from a provider within the plan’s network can affect the cost. Using an out-of-network pharmacy or physician can greatly increase the cost for which you will be responsible. This applies to both the Shingrix and Zostavax vaccines.
— Without Medicare:
If your Medicare enrollment or Medicare supplement plan won’t cover the vaccine, then you will be paying the full price out-of-pocket. The CDC recommends two doses of the vaccine, and the Shingrix vaccine tends to be a little cheaper than Zostavax. According to GoodRx, the Shingrix vaccine averages about $160 per shot. This comes to a total cost of about $320 for two doses of Shingrix. For Zostavax, you can expect to pay a little more. It runs about $220 per shot for a total cost of $440 for both doses. If you are unable to afford the vaccine, you should talk to your doctor or pharmacist about any patient assistance programs that might be available.
Steps For Getting Coverage For The Shingles Vaccine
If you currently only have Original Medicare, how can you get coverage for the shingles vaccine? First, you will need to sign up for a Medicare Advantage Plan or a Medicare Part D prescription drug plan to get coverage for the shingles vaccine. You should thoroughly research the plans available in your area. Eligibility for Advantage plans is based partly on where you live, so not all plans are available in all areas. An independent insurance agent can also help you choose the best Medicare Advantage plan for your needs.
Once you find a plan that meets your needs, you should check the coverage details to make sure that the shingles vaccine is covered. More than likely, you will need to meet a deductible before the plan pays for treatment. If you have already met your deductible and paid for the vaccine out-of-pocket, then you might be eligible for reimbursement for some of the charges. If you have questions about Medicare coverage for the shingles vaccine, there are many resources available at Medicare.gov. You can also give them a call at 1-800-633-4227 or TTY at 1-877-486-2048.
The Bottom Line
If you are already enrolled in Medicare coverage but have not yet had your shingles vaccine, you are probably wondering whether Medicare will cover it. If you only have Original Medicare, the shingles vaccine will not be covered. However, most Part D plans and Medicare Advantage plans will cover the vaccine subject to applicable copays and deductibles. You should always check the coverage details for your specific plan to determine what it will pay since each Advantage plan works a little differently.
Frequently Asked Questions
Does Medicare cover shingles vaccine at CVS?
Original Medicare will not cover the shingles vaccine at CVS. You can expect to pay around $160 for the Shingrix vaccine, and the total cost would be around $320 since two doses are recommended. If you are enrolled in a Medicare Part D plan, then your plan probably does provide coverage for the vaccine. In that case, you may only need to pay a copay for the vaccine once your deductible has been met.
Does Medicare cover shingles shots at Walgreens?
Original Medicare does not cover shingles shots at Walgreens. The total cost of both doses of Shingrix will probably cost you about $320 without insurance coverage. However, if you have a Medicare Advantage plan, then your plan likely provides some coverage for the shots. In that case, you might only be required to pay a copay for the shot, as long as you have already met your deductible for the year.
Is Shingrix free for seniors?
No, Shingrix is not free for seniors. Shingrix is also not covered by Original Medicare, so you will need to pay for the vaccine out-of-pocket if you only have Medicare Part A and Medicare Part B. If you are enrolled in a Part D drug plan, then the vaccine will probably be covered. You will still be responsible for paying any applicable copays and deductibles associated with your plan.
Is Shingrix covered by Medicare in 2022?
No, Original Medicare does not cover Shingrix in 2022. Most Medicare Part D plans will provide coverage for the Shingrix vaccine. You may only be charged a copay for the vaccine in that case. In some states, Medicaid might cover Shingrix. Medicaid coverage varies from state to state, so you should check with your local Medicaid office to be sure. Remember that you should always consult your doctor for medical advice. The vaccine does have some potential side effects, so your doctor can help you decide whether the vaccine is right for you.