Many people 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, and in most cases, no copay is required. So, does Medicare cover the shingles shot as well?
Keep reading as we provide all the details 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 sign 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.
- Medicare Part B does cover many different types of vaccines, although it does not cover the shingles vaccine.
- If you have a Medicare Advantage Plan that includes prescription drug coverage, you can likely receive the vaccine for just the amount of your copay.
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 fight off the virus’s effects, 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.
KEY TAKEAWAYS
- Original Medicare does not cover the shingles vaccine; however, the CDC still recommends that adults over 50 get two doses.
- Medicare Part D (purchased standalone or through the Medicare Advantage plan) provides prescription drug coverage, typically including the shingles vaccine.
- Even if your Medicare covers the shingles vaccine, you might still need to pay your deductible or a 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 not enrolled in a Part D plan, this vaccine will be an out-of-pocket cost.
- If you are enrolled in a Medicare Advantage plan, your plan likely includes prescription drug coverage, but you’ll want to double-check that it includes Part D drug coverage.
These Advantage plans are 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.
- 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, more traditional medical insurance, pays for doctor’s office visits, outpatient care, and many preventive services. It also covers many immunizations, such as the flu, pneumonia, and hepatitis B vaccines. Unfortunately, Part B does not cover the shingles vaccine.
Many people also wonder if Medicare covers eye exams. These Medicare Advantage plans often include additional benefits like dental and vision coverage.
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Cost Of Shingrix
So, how much does the shingles vaccine cost? The answer depends on whether you are enrolled in healthcare coverage for 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 approved by the FDA, and we will briefly mention its cost here.
Cost With Medicare:
The amount 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. As of January 1, 2023, all Medicare Part D beneficiaries are supposed to pay a $0 copay for the Shingrix vaccine.
However, we always encourage you to confirm with your healthcare provider since there are different premiums, coinsurance payments, deductibles, and coverage rules.
If your health insurance plan covers the vaccine, it may be subject to a copay. This ranges anywhere from $10 to $25 for most plans. If you have not yet met your annual deductible, 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 significantly increase the price you will be responsible for. This applies to both the Shingrix and Zostavax vaccines.
Cost Without Medicare:
If your Medicare enrollment or Medicare supplement plan doesn’t cover the vaccine, you will pay 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 $155 per shot, for a total cost of about $310 for two doses.
You can expect to pay a little more for Zostavax. It costs 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.
TIP
Certain Medicare Advantage plans, or Medicare Part D, can provide coverage for the shingles vaccine. These plans are not part of Original Medicare.
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 must 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 ensure the shingles vaccine is covered.
- You will likely 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, you might be eligible for reimbursement for some of the charges.
Many resources are available online if you have questions about Medicare coverage for the shingles vaccine. You can also call the Medicare office 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 and Medicare Advantage plans with Part D will cover the vaccine. As of January 1, 2023, there should be a $0 copay.
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
Original Medicare will not cover the shingles vaccine at CVS. The Shingrix vaccine costs around $160, and the total cost would be around $320 since two doses are recommended.
If you are enrolled in a Medicare Part D plan, your plan probably provides coverage for the vaccine. In that case, once your deductible has been met, you should pay a $0 copay for the vaccine.
Original Medicare does not cover shingles shots at Walgreens. Without insurance coverage, the total cost of both doses of Shingrix will probably be about $320.
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 if you have already met your deductible for the year.
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, the vaccine will probably be covered. However, you will still be responsible for paying any applicable copays and deductibles associated with your plan.
No, the Original Medicare does not cover Shingrix in 2024. However, most Medicare Part D plans will provide coverage for the Shingrix vaccine.
You may not even be charged a copay for the vaccine if you have Medicare Part D.
In some states, Medicaid might cover Shingrix. Medicaid coverage varies from state to state, so you should check with your local Medicaid office.
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 suitable for you.
You can find a Social Security Administration office near you by using our SSA office locator and searching for your closest location.
