Does Medicare Cover The Shingles Vaccine?

Fact Checked
Contributing expert: Kelly Blackwell, Certified Senior Advisor®
Updated: March 02, 2022

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Kelly Blackwell
Certified Senior Advisor (CSA)®
Kelly Blackwell
Certified Senior Advisor (CSA)®

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 vs. 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 aged 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 U.S. 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:
  • About one in three people will develop shingles at some point in their lifetime
  • More than 99% of people in the U.S. born before 1980 have had chickenpox ― even if you don’t remember it ― which poses risk for shingles
  • Your risk for getting shingles and complications from it increase as you get older
  • About one in 10 people who get shingles develop ongoing nerve pain
  • Shingles may lead to other complications involving the eye, including blindness; rarely, shingles may lead to pneumonia, hearing problems, brain inflammation, or death

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:
  • You have had a previous severe allergic reaction to any vaccine component or a previous dose of Shingrix
  • You’ve had a blood test that shows you have never been infected with the chickenpox virus ― in this case, you may decide to get the varicella vaccine to protect yourself from chickenpox
  • You are having an acute episode of shingles; wait until your symptoms are completely gone before getting the vaccine as it may prevent the recurrence of another episode

Does Medicare Cover the Shingles Vaccine?

Original Medicare Part A and Part B do not cover the shingles vaccine. The vaccine is covered under your Medicare prescription drug plan.

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 markup.
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, age 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

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