Does Medicare Part B Cover the Shingles Vaccine?
Understand how Medicare covers the shingles vaccine. Learn which plans provide coverage and what your potential out-of-pocket costs may be.
Shingles is a viral infection causing a painful rash, typically appearing as a stripe of blisters on one side of the body or face. It is caused by the varicella-zoster virus, the same virus responsible for chickenpox, which can reactivate years later. The shingles vaccine, primarily Shingrix, reduces the risk of developing shingles and its potential complications, such as postherpetic neuralgia, a condition involving long-lasting nerve pain.
Understanding Medicare Part B Vaccine Coverage
Medicare Part B covers certain medical services and preventive care, including some vaccines. It typically covers immunizations for influenza, pneumonia, and Hepatitis B for individuals at medium to high risk. Part B may also cover vaccines needed due to direct exposure to a harmful virus or bacteria, such as tetanus shots for an injury or rabies shots after an animal bite.
However, Medicare Part B does not cover the shingles vaccine. This is because the shingles vaccine is considered a prescription drug benefit rather than a medical service or routine preventive vaccine covered under Part B.
Shingles Vaccine Coverage Under Medicare Part D
The shingles vaccine is covered under Medicare Part D prescription drug plans. These plans are offered by private insurance companies approved by Medicare, covering a wide range of prescription medications. Each Part D plan maintains a formulary, a list of covered drugs, which includes all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), unless covered by Part B.
Beneficiaries enrolled in a Medicare Part D plan will find the shingles vaccine listed on their plan’s formulary. Due to the Inflation Reduction Act of 2022, effective January 1, 2023, individuals with Medicare Part D coverage pay nothing out-of-pocket for ACIP-recommended adult vaccines, including the shingles vaccine. This eliminates deductibles, copayments, or coinsurance for these vaccines. The standard deductible for Part D plans in 2025 is $590, but this does not apply to ACIP-recommended vaccines like Shingrix.
Shingles Vaccine Coverage Under Medicare Advantage Plans
Medicare Advantage Plans, also known as Medicare Part C, are offered by private companies approved by Medicare. These plans must provide all the benefits of Original Medicare (Parts A and B). Many Medicare Advantage plans also include prescription drug coverage, incorporating Part D benefits directly within their structure.
If a Medicare Advantage plan includes prescription drug coverage, it will cover the shingles vaccine. Out-of-pocket costs and rules, such as deductibles and copayments, for the shingles vaccine under a Medicare Advantage plan depend on the individual plan’s design. However, these plans must follow the same coverage requirements for ACIP-recommended vaccines as standalone Part D plans, ensuring $0 out-of-pocket costs for the shingles vaccine when Part D coverage is included.
Out-of-Pocket Costs and Accessing the Vaccine
For individuals with Medicare Part D or a Medicare Advantage plan that includes Part D coverage, the shingles vaccine, Shingrix, is available with no out-of-pocket costs. This includes no deductibles, copayments, or coinsurance for the vaccine or its administration when received through an in-network provider or pharmacy, a change due to the Inflation Reduction Act.
Before receiving the vaccine, confirm coverage details with your specific Medicare Part D or Medicare Advantage plan. This ensures no unexpected costs or specific network requirements. The shingles vaccine is widely available at various locations, including many pharmacies and doctor’s offices. Consulting with your plan directly or checking their website can provide precise information on preferred locations and any necessary procedures for obtaining the vaccine.