Does Medicare Pay For Shingles Shots?
Here’s the quick answer
Surprisingly, Original Medicare (Parts A and B) doesn’t cover the shingles vaccine, even though it covers other vaccines like the flu vaccine and pneumonia shot.
On the other hand, Medicare Part D—or a Medicare Advantage plan that includes Part D coverage—typically does cover the vaccine.
The devil is in the details
Every Part D plan is different, so your copay for a shingles vaccine could vary from one insurance plan to another. For this reason, it’s always good to check your plan’s formulary (or call your insurance company directly) to see which vaccines they cover and which tier those medications fall under.
Part D covers a lot more than the shingles vaccine, providing coverage for prescription medications. If you need the shingles vaccine and prescription drug coverage, see our guide on how to find the best Part D plan for you, or learn more about Part D first.
Does Medicare cover the new shingles vaccine (Shingrix)?
Your Part D plan (or Medicare Advantage prescription drug coverage) should cover the recently approved Shingrix vaccine, which consists of two doses in the span of a few months. Check with your plan to be sure it covers Shingrix.
What is the cost of the shingles vaccine with Medicare Part D?
Since every insurance plan is different, each Part D plan provides varying degrees of coverage for the shingles vaccine. Some plans may place the vaccine in Tier 1 (meaning great coverage and lower copays) while others may put it under Tier 3 (typically lower coverage and higher copays). Some plans may also have a deductible, meaning 100% of your vaccination or drug costs are on you until you meet the dollar amount specified by your insurance plan.
The best way to know how much a shingles vaccine may cost you is to call your insurance provider and ask.
What’s Shingrix, Zostavax, and shingles?
FDA approved in 2017, Shingrix is the leading preventive tool against shingles (herpes zoster virus). Shingles is caused by a once dormant chickenpox virus rearing its ugly head to give you a painful rash that can last for up to four weeks. For some, long-term pain continues even after the rash is gone, a condition known as postherpetic neuralgia.
Since 99% of people in the US have chicken pox by age 40, and since the risk of shingles increases with age, the Centers for Disease Control recommends that every healthy adult over 50 get Shingrix.1 Shingrix is over 90% effective at preventing shingles and postherpetic neuralgia, making it the preferred shingles shot.2 But for those who may be allergic to Shingrix, another shingles vaccine, Zostavax, can be used.
Zostavax may also be covered by Medicare prescription drug insurance (Part D), but again, you should check to be sure.
How do I get Part D?
Medicare Part D is a great way to get coverage, not only for the shingles vaccine but for prescription drugs as well. There are two ways to add Part D prescription drug coverage to your Medicare health insurance:
- If you have Original Medicare, you can add on a Part D plan by following this guide. Or call the number below and a licensed sales agent will help you find a plan.
- If you have Original Medicare or Medicare Advantage, you can switch to an Advantage plan that includes Part D coverage (as long as you are eligible for an enrollment period). You can enroll using our guide, or call the number below to receive help from a specialist.
Sources:
1. CDC.gov, “Shingles Vaccine”
2. CDC.gov, “Shingles Vaccine”
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