Shingles is a contagious viral infection that causes a painful rash and blisters on the skin from a condition known as postherpetic neuralgia (post-hur-PET-ik noo-RAL-juh). It is caused by the varicella-zoster virus, which also causes chickenpox in young people. After having chickenpox, the virus doesn’t die; it lies inactive. When you are older, the virus sometimes reactivates as shingles.
Typically, the rash forms on the trunk of the body, wrapping around the flank area. The blisters last from 10 to 14 days on average and remain contagious until they’ve scabbed over. The pain from the rash can last well after the blisters have gone away.
The Centers for Disease Control and Prevention (CDC) reports that more than 99% of Americans 40 years old and older have had chickenpox. Fortunately, there are FDA-approved vaccines available now to help prevent chickenpox. So, what do you do if you’ve already had chickenpox but don’t want to get shingles?
You get the shingles shot!
Key Takeaways
- Shingrix is a widely available name-brand shingles vaccine that protects the recipient for up to five years.
- Medicare Part A and Part B do not cover the shingles vaccine.
- Medicare Part D and Medicare Advantage plans with drug coverage will cover shingles vaccines.
- Shingles vaccines can vary in price from $155 to $207 without coverage.
- Medigap plans will not help with shingles vaccine costs, since Medicare Part A and Part B do not cover them at all.
- You can get a shingles vaccination at your primary care physician’s office or at most pharmacies in your area.
- If you are enrolled in Medicare and Medicaid (dual-eligible), you can qualify for a low-cost or even free shingles vaccine.
The Shingles Vaccine
The shingles vaccines will help prevent you from developing shingles. Many doctors recommend that older patients receive the vaccine to prevent developing shingles (and avoid the pain!).1CDC.gov, “What Everyone Should Know about the Shingles Vaccine (Shingrix)“, Accessed November 18, 2021
Shingrix, which is given in two injections, is said to protect against shingles for over five years. This name-brand vaccine is recommended to patients 50 or older.1CDC.gov, “What Everyone Should Know about the Shingles Vaccine (Shingrix)“, Accessed November 18, 2021
Zostavax was another popular shingles vaccine given in a single dose injection in the upper arm. However, Zostavax is no longer available in the United States, as of November 18, 2020.2CDC.gov, “What Everyone Should Know about Zostavax“, Accessed November 18, 2021
A quick web search shows that the average out-of-pocket cost for name-brand shingles vaccines is between $155 and $207. So, let’s look at your Medicare plans to see if your coverage will cover the vaccine’s cost.
Does Medicare Cover the Shingles Vaccine?
Yes, Medicare covers the shingles vaccine. But it isn’t covered by Medicare Part A (hospital insurance) or Medicare Part B (medical insurance), often referred to as Original Medicare, it’s covered through Part D prescription drug coverage. If your Medicare Advantage plan includes Part D benefits you can get it that way, too.3Medicare.gov, “Shingles shots“, Accessed November 18, 2021
Across the board, all Medicare prescription drug plans (Part D) cover commercially available vaccines, including Shingrix. However, the cost of coverage will vary. All Medicare Part D plans have copayments and nearly all have an annual deductible.4Medicare.gov, “Costs for Medicare drug coverage“, Accessed November 18, 2021
How Much Does a Shingles Shot Cost with Medicare?
The price for Shingrix can range from $155 to $2075Goodrx.com, “Shingrix“, Accessed November 18, 2021. If you have a Medicare Part D plan for your prescriptions, but you have not yet met your annual deductible, you could end up paying the full retail price. It does not really matter if you get it at Walgreens, CVS, Rite Aid, or Walmart, because the rules for your Part D plan require you to pay the deductible before cost-sharing begins.6Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 18, 2021
Shingrix is a name-brand drug, so it is not available in tier 1 of a Part D formulary, which generally covers generic prescription medications. Most plans cover these shots in tier 2 and a few bump them up to tier 3 in their formulary. So, if you have paid your Part D deductible in full for the year, look at your tier 2 copayments and you’ll have a good idea of your cost.7Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 18, 2021
TIP: If you have a Part D drug plan, but you are unlikely to meet your deductible from regular prescriptions, you can look for discount coupons on GoodRx and SingleCare so you don’t have to pay full price.
Does My Medicare Supplement Cover the Shingles Vaccine?
No. Medicare supplement plans (Medigap) only cover the gaps in your Part A and Part B Medicare coverage, which does not include vaccinations8Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 18, 2021.
How Do I Get the Shingles Vaccine?
The shingles vaccine can be obtained in two ways; at your primary care physician’s office, or at your pharmacy.
At Your Primary Care Physician’s Office
Before you go, ask your doctor’s office if you can receive the vaccine without a copay charge from the doctor. Most private insurance through Medicare Advantage will allow this, but an office visit on Original Medicare will charge you for both the visit and the vaccine, likely costing you hundreds of dollars. If you check beforehand, it won’t be a surprise when Medicare denies your claim for reimbursement.
At Your Pharmacy
Most major pharmacy chains, and some smaller, independent pharmacies, are also able to administer the Shingrix shingles vaccine. If you have Part D, this is where you’ll go.
You will still need a prescription from your doctor and you’ll need to ensure that the pharmacy you choose is in your network. That way they can bill your plan and you’ll only be paying your copayment Don’t forget, with Medicare Part D coverage you must pay your annual deductible before the plan starts paying its share.
Free Shingles Vaccine for Seniors
If you qualify for both Medicare and Medicaid, call your local Medicaid office about coverage for the shingles vaccine, which may be free or offered at a low cost. Rules are different in every state. If you are enrolled in the Social Security Administration’s Extra Help program, your cost will be minimal. The same is true if you have a Medicare Advantage SNP-D plan for dual-eligible people.9Medicaid.gov, “Early and Periodic Screening, Diagnostic, and Treatment“, Accessed November 18, 2021
It Pays to Be Protected
There you have it. Does Medicare cover the shingles vaccine?
Yes. Through Medicare Part C and Part D health insurance plans, you can get the shingles vaccine shot. Just don’t expect your insurance company to offer it for free. At a minimum, you will have a copayment or coinsurance.
Although Medicare Part D is optional, if you don’t sign up for it when you are first eligible and decide to sign up later, you could pay extra.
Getting coverage for common vaccines, like shingles, makes it worth it even if you don’t take prescriptions.
Citations
- 1CDC.gov, “What Everyone Should Know about the Shingles Vaccine (Shingrix)“, Accessed November 18, 2021
- 2CDC.gov, “What Everyone Should Know about Zostavax“, Accessed November 18, 2021
- 3Medicare.gov, “Shingles shots“, Accessed November 18, 2021
- 4Medicare.gov, “Costs for Medicare drug coverage“, Accessed November 18, 2021
- 5Goodrx.com, “Shingrix“, Accessed November 18, 2021
- 6Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 18, 2021
- 7Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 18, 2021
- 8Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 18, 2021
- 9Medicaid.gov, “Early and Periodic Screening, Diagnostic, and Treatment“, Accessed November 18, 2021