Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.
Shingles is a painful rash that typically develops on one side of either your face or torso. It’s caused by the same virus responsible for chickenpox (herpes zoster), which lies dormant in your body after recovery and may be reawakened as you age and your immune system weakens.
Shingrix is the only shingles vaccine approved for use in the United States. The vaccine is covered by Medicare prescription drug plans, either a stand-alone plan or as part of a Medicare Advantage Plan.
This article contains information for your consideration before you get the shingles vaccine. As with any decision you make about your health care, it’s a good idea to weigh the risks versus benefits and confer with a trusted health care professional.
Who Needs the Shingles Vaccine?
According to the Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices (ACIP) recommends the shingles vaccine for people 50 and older. It is a manufactured inactivated vaccine intended to prevent shingles. The vaccine is administered in two separate doses given by intramuscular injection, separated by two to six months.
The shingles vaccine is considered an important vaccine for seniors because our immune system weakens as we age. The recommendation for vaccination is based on the potential severity of symptoms and long-term complications.
A shingles vaccine called Zostavax is no longer used in the United States as of November 2020. If you received that vaccine, the CDC recommends talking with your doctor about getting the Shingrix vaccine.
|The CDC’s fact sheet on shingles lists these risks and potential complications:|
Shingrix is more than 90% effective at preventing shingles, but it does not prevent chickenpox.
The most common side effects of the vaccine are redness and pain at the injection site, headache, muscle pain, and fatigue. Some people also experience fever and nausea. Side effects are primarily due to your immune system response and should resolve within two or three days on their own.
|You should not get the Shingrix vaccine if:|
Does Medicare Cover the Shingles Vaccine?
|Medicare Part D||Medicare Advantage Plan (Part C)|
|You are eligible for the shingles vaccine if you have a stand-alone Medicare Part D prescription drug plan. Your plan pays after you satisfy your annual deductible. You are responsible for copay or coinsurance costs, depending on your plan’s rules. You may be able to receive the vaccine at your doctor’s office or pharmacy, and your costs will be less if you stay in-network. Check with your plan to find out the most cost-effective way for you to get your vaccine.||If you are enrolled in a Medicare Advantage Plan with prescription drug coverage (MA-PD), you are eligible for the shingles vaccine. Your costs will be lowest if you use an in-network provider. Check with your plan to find out what your costs are and where you should receive your injection. Your plan pays after you satisfy your prescription drug deductible, if applicable.|
How Much Does the Shingles Vaccine Cost?
Depending on your payment source, your cost and coverage for the shingles vaccine can vary. There are costs associated with the vaccine and its administration. Vaccines can be given at a pharmacy, doctor’s office, or clinic.
If you use your insurance coverage, the least expensive option is typically an in-network pharmacy. If you have an annual deductible for your prescription drug coverage, consider getting both doses of the vaccine within the same calendar year.
|Let’s look at four different possible options of paying for Shingrix:|
|You pay out-of-pocket without using insurance or a discount drug program.||The list price of Shingrix is around $162 per dose, but that doesn’t include administration costs or retail mark-up.|
|You ask your provider to bill your Medicare prescription drug insurance (a stand-alone Part D plan or a Medicare Advantage Plan with drug coverage).||Your out-of-pocket costs vary depending on your plan, where you get the vaccine, and whether or not you have met your annual deductible. If you qualify for Extra Help, which helps cover Part D out-of-pocket costs, you should only be responsible for a small copay. It’s always best to check with your plan first.|
|You bypass your insurance and use a prescription drug discount program.||These are widely available. You can check online or ask your pharmacist which plans are used in your area. A discounted dose of Shingrix can range from $150 to $200 but doesn’t include administration costs.|
|You have Medicaid and pay a small copay for the vaccine you receive from an in-network pharmacy.||Thirty-eight states and the District of Columbia have expanded Medicaid benefits to include the Shingrix vaccine. Check with your State Health Insurance Assistance Program (SHIP) to determine if the vaccine is covered.|
Can You Get the Shingles Vaccine for Free?
The shingles vaccine is manufactured by GlaxoSmithKline (GSK) Biologicals, a pharmaceutical company. GSK has a patient assistance program that may provide the vaccine to you at no cost if you meet these eligibility criteria:
- You don’t have prescription drug coverage or a Part D plan and have spent at least $600 during the calendar year.
- You are an adult, 19 or older.
- You live in the U.S., Puerto Rico, or the District of Columbia.
- You don’t qualify for Puerto Rico’s Government Health Plan.
- Your maximum monthly gross income does not exceed certain limits, depending on where you reside and your household size.
- You apply through your health care provider, who will register for the patient assistance program and submit your application.
Learn More From Our Sources
- CDC | Shingles (Herpes Zoster) Vaccine Information | Last accessed October 2021
- CDC | Shingles: What Everyone Should Know | Last accessed October 2021
- CDC | Shingles Fact Sheet | Last accessed October 2021
- GSK | GSK Patient Assistance Program | Last accessed October 2021
- Medicare | Coverage of Shingles Shots | Last accessed October 2021
- Medicare | Part D Drug Coverage | Last accessed October 2021
- Medicare | Medicare Advantage Plans | Last accessed October 2021
- Medicare | Extra Help | Last accessed October 2021
- NCOA | Vaccines For Seniors Covered by Medicare | Last accessed October 2021
- Shingrix | Cost and Coverage Information | Last accessed October 2021
- SHIP | State Health Insurance Assistance Program | Last accessed October 2021