Does Medicare Pay for Shingles Shots?
Learn how Medicare covers your shingles vaccine, including plan options, potential costs, and where to get your shot.
Shingles is a viral infection that can cause a painful rash and lead to long-term nerve pain. Vaccination is highly effective at preventing shingles and its complications. The Centers for Disease Control and Prevention (CDC) recommends the Shingrix vaccine for healthy adults aged 50 and older. Shingrix is more than 90% effective at preventing shingles and postherpetic neuralgia (PHN).
Medicare Part D Coverage for Shingles Shots
Medicare Part D, which encompasses prescription drug plans, is the primary avenue for coverage of shingles shots. These plans are offered by private insurance companies approved by Medicare. Individuals enroll in a Part D plan to receive prescription drug benefits, which include vaccine coverage. Part D plans must incorporate most commercially available vaccines, such as the shingles vaccine, into their formularies.
Since January 1, 2023, the Inflation Reduction Act (IRA) eliminated out-of-pocket costs for adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). This means that for the shingles vaccine, beneficiaries with Medicare Part D coverage pay nothing. There are no deductibles, copayments, or coinsurance applied to ACIP-recommended vaccines under Part D.
This policy applies whether an individual is enrolled in a standalone Medicare Part D plan or a Medicare Advantage plan that includes prescription drug coverage. The elimination of cost-sharing aims to improve access to preventive vaccines. The current $0 cost for these vaccines represents a financial benefit for eligible individuals.
Other Medicare Coverage Options
Original Medicare, which consists of Part A (Hospital Insurance) and Part B (Medical Insurance), generally does not cover routine vaccinations like the shingles shot. Part A primarily covers inpatient hospital stays. Part B covers outpatient care, including doctor visits and certain preventive vaccines, but it specifically excludes the shingles vaccine. If an individual only has Original Medicare, they are responsible for the full cost of the shingles vaccine.
Medicare Advantage Plans, also known as Part C, are an alternative to Original Medicare provided by private companies. Many Medicare Advantage plans include prescription drug coverage, incorporating Part D benefits. If a Medicare Advantage plan offers drug coverage, it will cover the shingles vaccine under the same Part D provisions, including the $0 out-of-pocket cost established by the Inflation Reduction Act. Medigap policies do not include prescription drug coverage and therefore do not cover the shingles vaccine.
Understanding Your Out-of-Pocket Costs
For individuals with Medicare Part D or a Medicare Advantage plan that includes prescription drug coverage, the out-of-pocket cost for the shingles vaccine is currently $0. This means beneficiaries are not required to pay a deductible, copayment, or coinsurance for the vaccine. This change, effective January 1, 2023, resulted from the Inflation Reduction Act. The legislation ensures that ACIP-recommended vaccines, including Shingrix, are fully covered without cost-sharing.
Before this change, individuals with Part D could face varying out-of-pocket expenses for the shingles vaccine. In 2021, the average out-of-pocket cost for the shingles vaccine for Part D enrollees was around $77. The full price of the two-dose Shingrix vaccine without any insurance coverage can range from approximately $367 to $400. The current policy eliminates these costs, making the vaccine more accessible.
Accessing Your Shingles Shot
Once you understand your Medicare coverage for the shingles vaccine, the next step is to obtain the immunization. The Shingrix vaccine is administered as a two-dose series, with the second dose typically given two to six months after the first. You can generally receive your shingles shot at most local pharmacies or your doctor’s office.
It is advisable to contact your chosen pharmacy or doctor’s office beforehand to confirm they administer the shingles vaccine and can bill your Medicare Part D plan directly. Most Medicare Part D enrollees receive their shingles vaccine at a pharmacy, as many doctor’s offices may not be set up to bill Part D directly for vaccinations. When visiting the location, remember to bring your Medicare card and your Part D or Medicare Advantage plan card to ensure proper billing. While a prescription is not typically required for the shingles shot, verifying coverage and any specific procedural requirements with your provider or pharmacy is always a prudent step.