The shingles vaccine is covered under Medicare Part D. Part D covers most commercially available vaccines. In this article, we’ll cover who is eligible for the shingles vaccine, what the costs are, and other common questions about Medicare and shingles.
What is shingles?
Shingles is a painful rash caused by the dormant chicken pox virus being reactivated. Symptoms of shingles include a blistering rash, a painful burning sensation on the skin, itchiness, fatigue, and fever. Nearly one out of three people will develop shingles over the course of their life,1 and the risk of getting shingles increases as you get older. The CDC recommends that everyone over the age of 60 gets the shingles vaccine.
Who is eligible?
Most vaccines are covered under Medicare Part B, but the shingles vaccine works a little differently. To have your shingles vaccine covered by Medicare, you need prescription drug coverage. With Medicare, this can take two forms:
- If you have Original Medicare (Part A and Part B), you can enroll in a Part D prescription drug plan.
- You can also opt for a Medicare Advantage Plan that bundles the benefits of Parts A, B, and D into one package.
To be eligible for Part D, you must be a citizen or legal resident of the US, and you must qualify for and be enrolled in Part A or Part B (or both). To be eligible for Parts A and B, you must meet one of these criteria:
- You are 65 or older.
- You have a disability.
- You have End-Stage Renal Disease.
How much does the shingles shot cost?
Both stand-alone Part D and Medicare Advantage plans are provided by private insurance companies, so the exact cost of your shingles shot can vary depending on the specific plan and provider you choose. Medicare requires all Part D plans to cover the vaccine, though, so as long as you get it at a doctor’s office or pharmacy in your plan’s network, it will be covered.
Most plans will require you to pay a copayment for the shot, and unfortunately, it can be expensive. If you haven’t met your deductible for the year, the shot can cost over $200, and even if you have, copays can be as high as $100.2 Pharmacies are generally the cheapest place to get a shingles shot.
What are the coverage limitations?
There are a few limits on Medicare’s coverage of the shingles vaccine.
- To have the shingles vaccine fully or partially covered by your Part D plan, you need to have met your drug plan’s deductible. If you have not met your deductible for the year, you will be expected to pay most, if not all, of the cost for the shingles vaccine. Specific deductible amounts vary from plan to plan.
- You need to have the shot administered at a doctor’s office or pharmacy that is in your plan’s network. Like deductibles, provider and pharmacy networks vary from plan to plan. If your regular pharmacy or doctor’s office is covered by your plan, a vaccine administered there should also be covered.
As long as you meet these requirements, you should be able to have the vaccine administered at the pharmacy or doctor’s office of your choice.
If you have any more questions about your Medicare coverage, visit our FAQ page, where you’ll find answers to all the most common Medicare questions.
1 Centers for Disease Control and Prevention, “Prevent Shingles”
2 Consumer Reports, “Why Does My Shingles Vaccine Cost So Much?”