- The Centers for Disease Control and Prevention (CDC) recommends healthy adults age 50 and older get the shingles vaccine.
- Original Medicare (Part A and Part B) won’t cover the vaccine.
- Medicare Advantage or Medicare Part D plans may cover all or a portion of the shingles vaccine costs.
As you get older, you’re more likely to get shingles. Fortunately, there is a vaccine that can prevent the condition.
Medicare Part A and Part B won’t cover the shingles vaccine. However, you may be able to get coverage through a Medicare Advantage or Medicare Part D plan.
Keep reading to find out how to get Medicare coverage for the shingles vaccines or get financial help if your plan doesn’t cover the vaccine.
Original Medicare — Part A (hospital coverage) and Part B (medical coverage) — doesn’t cover the shingles vaccine. However, there are other Medicare plans that may cover at least part of the costs. These include:
- Medicare Part C. Medicare Advantage (Part C) is a plan you can buy through a private insurance company. It may offer additional benefits not covered by original Medicare, including some preventive services. Many Medicare Advantage plans include prescription drug coverage, which would cover the shingles vaccine.
- Medicare Part D. This is the prescription drug coverage portion of Medicare and typically covers “commercially available vaccines.” Medicare requires Part D plans to cover the shingles shot, but the amount it covers can be very different from plan to plan.
Making Sure You’re covered
There are a few steps you can take to make sure your shingles vaccine is covered if you have Medicare Advantage with drug coverage or Medicare Part D:
- Call your doctor to find out if they can bill your Part D plan directly.
- If your doctor can’t bill your plan directly, ask your doctor to coordinate with an in-network pharmacy. The pharmacy might be able to give you the vaccine and bill your plan directly.
- File your vaccine bill for reimbursement with your plan if you can’t do either of the options above.
If you have to file for reimbursement, you’ll have to pay the full price of the shot when you get it. Your plan should reimburse you, but the amount covered will vary based on your plan and if the pharmacy was in your network.
The amount you pay for the shingles vaccine will depend on how much your Medicare plan covers. Remember that if you only have original Medicare and no prescription drug coverage through Medicare, you may pay full price for the vaccine.
Medicare drug plans group their medications by tier. Where a drug falls on the tier can determine how expensive it is. Most Medicare drug plans cover at least 50 percent of a drug’s retail price.
PRice ranges for the shingles vaccine
Shingrix (given as two shots):
- Deductible copay: free to $164 for each shot
- After deductible is met: free to $164 for each shot
- Donut hole/coverage gap range: free to $74 for each shot
- After the donut hole: $7 to $8
To find out exactly how much you will pay, review your plan’s formulary or contact your plan directly.
Currently, there is only one vaccine available that has been approved by the FDA to prevent shingles. It is a recombinant zoster vaccine with the brand name Shingrix.
The FDA approved Shingrix in 2017. It’s the
A note on Zostavax
At the time this article was first written, the zoster live vaccine (Zostavax) was another FDA-approved option for shingles vaccination. However, the sale and use of Zostavax has been discontinued in the United States as of
November 18, 2020.
Shingles is a painful reminder that herpes zoster, the virus that causes chickenpox, is present in the body. An estimated
Shingles affects about one-third of people who’ve had chickenpox, leading to burning, tingling, and shooting nerve pain. The symptoms can last for 3 to 5 weeks.
Even when the rash and nerve pain go away, you can still get postherpetic neuralgia. This is a type of pain that lingers where a shingles rash begins. Postherpetic neuralgia can cause the following symptoms:
- problems completing daily activities
- problems sleeping
- weight loss
The older you are, the more likely you are to have postherpetic neuralgia. That’s why preventing shingles can be so important.
- Medicare Advantage and Medicare Part D should cover at least a portion of the shingles vaccine’s cost.
- Check with your doctor before getting the vaccine to find out how it will be billed.
- The CDC recommends the Shingrix vaccine, but it’s not always available, so check with your doctor’s office or pharmacy first.