Does Medicare Cover Shingles Vaccinations?
Demystify Medicare coverage for the shingles vaccine. Learn about applicable plans, potential costs, and practical steps to receive it.
The shingles vaccine helps prevent shingles, a painful rash caused by the varicella-zoster virus, which also causes chickenpox. This virus can reactivate later in life, leading to shingles. Medicare generally covers the shingles vaccination, helping beneficiaries access this immunization.
Shingles Vaccine and Medicare Part D
The primary way Medicare covers the shingles vaccine is through Medicare Part D, which encompasses prescription drug plans. Medicare Part D plans are offered by private insurance companies approved by Medicare, and beneficiaries enroll in these plans to receive coverage for their medications. The shingles vaccine, Shingrix, is treated as a prescription drug under Part D. As of January 1, 2023, there are generally no out-of-pocket costs for recommended adult vaccines, including the shingles vaccine, under Part D. This eliminates deductibles, copayments, and coinsurance for the vaccine, dispensing fees, and administration fees for Part D enrollees.
Distinguishing Vaccine Coverage: Part B vs. Part D
Understanding which part of Medicare covers a vaccine can be confusing, as coverage varies depending on the specific vaccine; while the shingles vaccine falls under Medicare Part D, certain other vaccines are covered under Medicare Part B, which is medical insurance. For example, Medicare Part B covers preventive vaccines such as flu shots, pneumonia shots, and Hepatitis B shots for those at medium or high risk. Additionally, Part B covers vaccines administered after an injury or direct exposure to a harmful virus or bacteria, such as tetanus or rabies. For vaccines covered by Part B, beneficiaries typically pay nothing out-of-pocket if their provider accepts Medicare assignment. This distinction highlights that the shingles vaccine is categorized differently, aligning with prescription drug coverage rather than standard medical or preventive service coverage.
Out-of-Pocket Costs for Shingles Vaccine
Since the shingles vaccine is covered under Medicare Part D, beneficiaries enrolled in a Medicare Part D plan or a Medicare Advantage plan that includes prescription drug coverage generally pay nothing out-of-pocket for the vaccine. This is due to a significant change that occurred on January 1, 2023, with the implementation of the Inflation Reduction Act. This legislation eliminated cost-sharing for adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) when covered by Medicare Part D. This includes the vaccine cost, dispensing fees, and administration fees, regardless of whether a deductible has been met or the coverage phase.
Steps to Obtain the Vaccine
Obtaining the shingles vaccine involves a few straightforward steps; beneficiaries should confirm their enrollment in a Medicare Part D plan, either a stand-alone plan or through a Medicare Advantage plan that includes drug coverage. The vaccine, Shingrix, is administered as a two-dose series, with the second dose typically given two to six months after the first. For individuals who are immunocompromised, the second dose may be given sooner, between one to two months after the first. Completing both doses is important for maximum effectiveness. Beneficiaries can generally receive the vaccine at a pharmacy or a doctor’s office that participates with their Part D plan. When getting the vaccine, bring your Medicare card and your Part D plan card.