January 23rd 2023
By Ari Parker
The shingles vaccine (SHINGRIX) is covered for most Medicare beneficiaries. Learn what you need to know, including when and where to get your shots.
About half of all shingles cases occur in older adults. People that experience shingles are more at risk to face other health issues like stroke and heart attack as well. It’s important to take preventative measures against the virus and check how Medicare covers the vaccine.
Original Medicare does not cover the shingles shot (SHINGRIX), but most insurance plans with prescription drug coverage do. All Medicare Part D (prescription drug) and Medicare Advantage + Part D plans cover SHINGRIX and patients pay nothing out of pocket per dose.
Key Takeaway: The shingles vaccine is free if you have Medicare Part D (prescription drug) coverage.
Shingles, also called the herpes zoster, is caused by the same virus as chickenpox. This virus is known as the varicella-zoster virus. For those that have had chickenpox, the virus can remain dormant for years and then reactivate to cause shingles. Shingles is characterized by a painful rash.It could look like a stripe of red spots that turn into blisters. The virus typically starts out with a tingling or burning sensation that then forms into the rash. People may also feel fever, headache, fatigue, and sensitivity to light.
Because older adults are more likely to have weaker immune systems, they’re more likely to develop complications due to shingles. As such, the SHINGRIX vaccine is especially recommended for those aged 50 and up.
1 in 3 people in the US will get shingles in their lifetime. The virus causes an itchy and painful skin rash as a result of reactivating the chickenpox virus. A weakened immune system or certain medical conditions can trigger the reactivation of the virus.
SHINGRIX boosts your body’s protection against shingles and is proven to be 90% effective in preventing shingles in adults 50 years or older. SHINGRIX is given in a two-dose series, and your second shot should be administered 2-6 months after your first. If you’ve already received your first shot, you can sign up for reminders so you don’t forget your second dose.
Without insurance, the cost of the shingles vaccine can vary, but it can cost upwards of $213. If you have Medicare Part D coverage, you won't have to pay anything for SHINGRIX.
For those with prescription drug coverage through Medicare, the SHINGRIX vaccine will most likely cost $0 out of pocket if you receive your shots at a pharmacy. It’s important to note that most Medicare Part D enrollees receive SHINGRIX at a pharmacy because most doctors cannot bill for vaccinations administered to Part D beneficiaries.
For those without prescription drug coverage, costs will vary and you should consult your healthcare provider to determine the cost.
The shingles vaccine is widely available at most pharmacies, urgent care centers, and community health clinics. Your primary care physician can also administer the shingles vaccine. Make sure that your doctor’s office can bill the vaccine under Medicare Part D.
Medicare Part B covers most preventative care like vaccines but there are a few exceptions. Like with the shingles vaccine, Medicare Part D will also cover many vaccines that Part B doesn’t.
Part B covers the following vaccines:
COVID-19
Flu
Hepatitis B
Pneumonia
Part D covers the following vaccines:
Hepatitis B
RSV
Shingles
Tdap
Have more questions about what Medicare can and can’t cover? We're here to help! Give us a call at (855) 900-2427 or schedule a free consultation to get your Medicare questions answered.
