Vaccines have been at the forefront of many minds since the beginning of the pandemic. We are frequently informed about yearly vaccines such as the flu and COVID vaccines. Most of us get vaccinated as children against diseases like measles, meningitis, pneumonia, and others. It is important to remember that we need certain vaccines as adults, too — one of which is the shingles vaccine. Shingrix, now preferred over the previously used live vaccine Zostavax, is recommended by the CDC for all adults over age 50 and some younger adults at higher risk for shingles infection.
The shingles vaccine is a 2-dose series recommended for those 50 and older and some younger adults to protect against shingles (herpes zoster).
Medicare Part D and most Medicare Advantage Plans cover the shingles vaccine.
You may be able to get the shingles vaccine at no cost to you, even if you do not have coverage through one of these plans.
In this article, we explain whether Medicare covers the shingles vaccine and where to get one.
What is shingles?
Shingles outbreaks are caused by varicella zoster, the same virus that causes chickenpox. The virus lies dormant in your body and can later be reactivated and appear as shingles. If you have ever had chickenpox, you are at risk for developing shingles.
Shingles develop as a painful, sometimes burning rash, typically on one side of the face or body. The pain can be severe and can sometimes cause long-term effects. Other possible symptoms include fever, chills, headache, or upset stomach. Some people with shingles can feel a tingling or burning sensation before the rash becomes visible.
Keep in mind that you cannot get shingles from someone who has shingles. However, you can get chickenpox from someone who has shingles if you have never had chickenpox or are not vaccinated against it.
Most people only have shingles once, but it is possible to get recurrent outbreaks over your lifetime. You are more likely to get shingles if your immune system is compromised or if you are taking certain medications that suppress your immune system.
Some high-risk individuals include those who:
- Are on chemotherapy
- Take immunosuppressive drugs
- Have HIV
- Have certain cancers
Possible complications of shingles include long-term nerve pain, called postherpetic neuralgia, that can last years after the initial shingles infection occurs. Vision loss or blindness may occur if the shingles rash gets near or into the eye. Rare complications also include pneumonia, hearing loss, and brain inflammation.
Is the shingles shot covered by Medicare plans?
Medicare coverage for the shingles vaccine varies based on the type of Medicare that you have. Before getting the vaccine, it is essential to check your plan to see if vaccines like Shingrix are covered for you.
Original Medicare (Part A and B)
Medicare Parts A & B do not provide coverage for the shingles vaccine. Medicare Part B does provide coverage for the flu and pneumonia vaccines in certain situations but not for the shingles vaccine.
Medicare Advantage (Part C)
Most Medicare Advantage plans cover the Shingrix vaccine. Your Medicare Advantage plan must include prescription drug coverage for this to apply. Most Medicare Advantage plans do include this coverage, but you should check your plan to be sure before getting the vaccine.
Medicare Part D
Medicare Part D does cover the shingles vaccine. As of January 1, 2023, the shingles vaccine is covered at no additional cost to the patient. This no out-of-pocket coverage is due to the Inflation Reduction Act, which eliminated all out-of-pocket costs for any vaccine recommended for adults by the Centers for Disease Control (CDC).
Medigap plans do not provide coverage for medications, including the shingles vaccine. It is illegal for any insurance company to sell a Medigap plan that includes prescription drug coverage. However, with Medigap, you can add Medicare Part D coverage at an additional cost.
How much does a shingles vaccine cost with Medicare?
If you have coverage through Medicare Part D or a Medicare Advantage plan that covers medications, you can get a shingles vaccine at no cost as of January 1, 2023. Until the end of 2022, you may have been required to pay a co-pay of up to $50. That fee has been eliminated thanks to the Inflation Reduction Act.
If you do not have Medicare Part D or a Medicare Advantage plan with drug coverage, you may have to pay $180 or more for each Shingrix vaccine you receive. Cost can vary depending on where you get your vaccine.
Does my health insurance plan cover the shingles vaccine?
The Affordable Care Act (ACA) requires all Marketplace plans to cover vaccines, including the shingles vaccine, at no additional cost.
Up to 96% of private insurance plans also cover the shingles shot. You may have to meet specific criteria to receive this benefit. Most insurance companies provide coverage if you are over age 50 or at high risk for getting shingles or complications from the infection.
Aetna, Humana, and United all consider the shingles vaccine to be “necessary” and provide coverage for the vaccine, in most cases at no additional cost.
Where to get the shingles vaccine?
You can get the shingles vaccine in several locations. It is essential to check your plan to see if your insurance requires a specific location for vaccination.
Most clinics and healthcare provider’s offices offer the shingles vaccine. To get the vaccine at no cost, you must be sure that your provider is eligible to bill Medicare Part D or your Medicare Advantage plan. If your provider can’t bill Medicare, you may have the option to submit the bill for reimbursement.
Most pharmacies now administer vaccines, including the Shingrix vaccine. Most of these pharmacies can bill Medicare or your insurance company, making the vaccine free to you. Getting your vaccine at a pharmacy is a great option due to convenient locations and, often, no need for an appointment.
Why does Medicare not cover the shingles vaccine?
Medicare Parts A and B do not cover any medications or vaccines, including the shingles vaccine. Part A covers hospital stays, skilled nursing, and home health. Part B covers outpatient care, durable medical equipment, and some preventive care. Medicare Part D does cover the shingles vaccine.
Can I get the shingles vaccine for free?
The vaccine is free if you have Medicare Part D, a Medicare Advantage plan with drug coverage, or a marketplace plan. If you don’t have these coverages, you may qualify for a free vaccine. Most states have vaccine programs that provide free vaccines for children and uninsured adults.
Do you need a prescription for the shingles vaccine?
No. You do not need to have a prescription from your healthcare provider to get the shingles vaccine. If you meet the CDC’s recommended guidelines for vaccination, a prescription is unnecessary.
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