Does Medicare cover the shingles vaccine?

Does Medicare cover the shingles vaccine?

It’s a good question to ask, especially if you’re older. Why?

• About 1 million cases of shingles (also known as the herpes zoster virus) are treated in the U.S. every year.¹
• About 1 in 3 adults will develop shingles in their lifetime.
• And most people who develop shingles are 50 or older.

Here’s what you can do to help prevent it:

The Centers for Disease Control and Prevention recommends the shingles vaccine for everyone age 50 or older.²

• The current shingles vaccine recommended by the Centers for Disease Control and Prevention is over 90% effective at preventing shingles and long-term nerve pain.³
• Even if you’ve had shingles before, getting vaccinated can help prevent future outbreaks.
• The vaccine is safe for most adults. See your doctor before getting the shingles vaccine if you have a weakened immune system.

Getting the shingles vaccine can help you avoid developing:⁴

• A painful, itchy rash with blisters, typically on one side of the body
• Severe pain, burning, tingling, and numbness around the affected area
• Long-term nerve pain, even after the rash is gone

Sounds pretty bad, right? If you have Medicare, maybe you’re wondering: Does Medicare cover the shingles vaccine?

Here’s what you need to know:

Medicare coverage for the shingles vaccine

If you’re enrolled in a Medicare Part D plan (prescription drug coverage):

• Medicare covers the full cost of the shingles vaccine, with no out-of-pocket expenses⁵
• The Inflation Reduction Act of 2022 eliminated costs and deductibles for the shingles vaccine, saving Medicare beneficiaries an estimated $400 million in out-of-pocket costs.⁶

How to get Medicare Part D coverage for the shingles vaccine

To ensure your shingles vaccine is covered, you need to be enrolled in a Medicare Part D prescription drug plan. There are two options:⁷

1. Standalone Medicare prescription drug plan: Adds prescription drug coverage to Original Medicare (Parts A & B).
2. Medicare Advantage prescription drug plan: Combines Medicare Parts A, B, and D into one plan, often with additional benefits not offered with Original Medicare.

Cost of the shingles vaccine

Prior to 2023, Medicare beneficiaries often had to pay out-of-pocket for the shingles vaccine or be reimbursed later.

• Without insurance, the out-of-pocket costs for the shingles vaccine is about $400 for the two-dose vaccination.⁸
• With insurance, Medicare Part D fully covers the cost of the vaccine for shingles with no deductible, copay or coinsurance⁵

Factors that may affect your coverage

Although Medicare covers the shingles vaccine at no cost, a few factors may affect your experience:

• Network providers: Make sure you receive the vaccine from an in-network pharmacy or healthcare provider to avoid unexpected charges.
• Part D enrollment: If you’re not currently enrolled in Medicare Part D, you’ll need to sign up during the Annual Enrollment Period or during a qualifying special enrollment period.⁹

What to do before getting the shingles vaccine:

If you’re enrolled in a Medicare Part D plan, you can get the shingles vaccine for free. Before scheduling your vaccine, take these steps:

1. Confirm coverage: Contact your Medicare Part D provider to verify full coverage and ensure the vaccine is administered at a covered location.
2. Schedule your shot: You can receive Shingrix at a doctor’s office or pharmacy.
3. Understand timing: The Shingrix vaccine requires two doses, typically given 2 to 6 months apart, so you’ll need two appointments.

Find a Medicare Part D plan for shingles vaccine coverage

Does Medicare cover the shingles vaccine? It does if you’re enrolled in a Medicare Part D plan. But if you’re not enrolled in Medicare or a Part D plan, we can help.

Just give us a call at (844) 747-6721 to speak with a licensed health insurance agent or find a licensed health insurance agent in your area. We’ll help you review your Medicare Part D options and walk you through the enrollment process.