Original Medicare (Part A and Part B) doesn’t cover the shingles vaccine. Medicare Advantage or Medicare Part D plans may cover the costs of the shingles vaccine.
The Centers for Disease Control and Prevention (CDC)
However, Medicare Part A and Part B do not cover the shingles vaccine. But, 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, other Medicare plans 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” needed to prevent illness. Medicare requires Part D plans to cover the shingles shot.
Making sure you’re coveredYou can take a few steps 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 may vary based on if the pharmacy is 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, or around $180.
If you have Medicare Advantage or Medicare Part D, you should not have to pay any out-of-pocket costs for the Shingrix vaccine.
To find out exactly how much you will pay, review your plan’s formulary or contact your plan directly.
Cost-saving tips
- If you qualify for Medicaid, check with your state’s Medicaid office about coverage for the shingles vaccine, which may be free or offered at a low cost.
- Look for prescription assistance and coupons on websites that help with medication costs. Examples include Optum Perks and NeedyMeds.org. These sites can also help you search for the best deal on where to get the vaccine.
- Contact the vaccine’s manufacturer directly to ask for potential rebates or discounts. GlaxoSmithKline manufactures the Shingrix vaccine.
Currently, one vaccine has FDA approval to prevent shingles. It is a recombinant zoster vaccine with the brand name Shingrix.
Shingrix is over
The FDA approved Shingrix in 2017. It’s the
Learn more about the procedure for getting the Shingrix vaccine.
Getting the shingles vaccine can substantially reduce your risk of shingles and shingles complications.
Shingles affects about
Some people also get postherpetic neuralgia, which is pain that continues after recovery from the shingles rash.
The older you are, the
Medicare Advantage and Medicare Part D typically cover the cost of the shingles vaccine.
You can also check with a doctor before getting the vaccine to find out how it will be billed.