Does Medicare Cover the Shingles Vaccine?
Medicare Parts A and B do not cover the shingles vaccine, but the vaccine is usually covered under a Medicare Part D prescription drug plan. The CDC advises people aged 50 and above to receive this vaccine. While Medicare Part B covers certain other vaccines (such as flu and pneumonia) as preventive care, the shingles vaccine is not included.
If you have a prescription drug plan like Medicare Part D (either as an add-on to original Medicare or as part of a Medicare Advantage plan), it will cover the cost of the shingles vaccine. These plans are required to cover all available vaccines necessary to prevent illnesses (except those already covered by Part B).
How Much Does the Shingles Vaccine Cost Under Medicare Part D?
Beginning in 2023 and moving forward, the Inflation Reduction Act will remove any costs associated with vaccines that the CDC’s Advisory Committee on Immunization Practices recommends for adults. This applies to individuals with prescription drug coverage from Medicare Part D or a Medicare Advantage plan who wish to obtain the shingles vaccine.
If you don’t have prescription drug coverage, you might have to pay over $180 out-of-pocket costs for each dose of Shingrix (a shingles vaccine approved by the FDA in 2017).
Do I Need the Shingles Vaccine?
Everyone may carry a dormant version of the virus that can cause shingles. According to the CDC, over 99% of people born before 1980 in the United States have had chickenpox, even if they don’t remember experiencing the illness.
The United States introduced a vaccine for chicken pox in 1995. As the varicella-zoster virus that causes chickenpox can reappear later in life as shingles, it is recommended to get vaccinated against shingles.
For individuals aged 50 to 69, two shingles shots of the Shingrix vaccine can prevent shingles with 97 percent effectiveness. For those 70 years old or older, the vaccine can prevent shingles with 91 percent effectiveness.
Medicare Part A and Part B do not cover the shingles vaccine, but a Medicare Part D prescription drug plan may cover it. Depending on the type of vaccine and where it is received, the cost can range from $200-$300. Our insurance agents are available to determine if your Medicare Coverage covers the shingles vaccine.
How do I get prescription drug coverage?
You can either get a stand-alone Part D plan to add to your Original Medicare or purchase a Medicare Advantage plan that provides medical and drug coverage in its benefits package.
What if I can't afford Medicare drug coverage?
If you struggle to pay for a Medicare Part D plan, you might be eligible for the Extra Help program. This program assists people with low income and limited assets in paying for premiums and out-of-pocket expenses related to Part D drug coverage. More good news: the Inflation Reduction Act will also increase the income eligibility level for the Extra Help program beginning in 2024.