Traditional Medicare doesn’t cover the shingles vaccine, but a Part D plan could provide you with benefits. While it doesn’t cover the vaccine, Medicare Part B will cover the doctor’s visit that gets you a prescription for Shingrix.

Those of us that had chickenpox know how awful it felt and want to be sure we get the shingles vaccine. Keep reading to learn more about getting your shingles vaccine covered, the potential cost, and where to go for your vaccine.

Does Medicare Cover the Shingles Vaccine?

All Medicare Part D or a Medicare Advantage plan that includes a Medicare prescription drug plan will cover the Shingles vaccine. Prescription drug plans offer coverage for Shingrix.

Is Shingrix Covered by Medicare Part D?

Private insurance companies offer Part D prescription drug plans covering the Shingrix vaccine. You must have a prescription and use an in-network pharmacy.

Does Part D Cover the Zoster Vaccine?

Yes, Part D plans cover the herpes zoster (shingles) vaccine. The Zostavax vaccine may have coverage. Consult your insurance company for information on your plan’s drug formulary.

How Much Does the Shingles Shot Cost with Medicare?

If you have a Part D or plan that includes medications, you’ll likely pay a small copayment for your vaccine. Most plans consider Shingrix a Tier 3 Brand-Name medication.

In most cases, the cost is less than $50 per dose. Contact your plan to find out the specific costs you’ll incur. If there is a deductible on your policy, you must meet the deductible before you benefit from cost-sharing.

Medigap healthcare insurance doesn’t include Part D, you’ll need a separate policy for prescription coverage.

Those that don’t have prescription drug coverage could pay over $300 for two doses of Shingrix. A prescription might not be necessary if you’re paying for the vaccine.

Where Do I Get the Shingles Shot?

Using health insurance at an in-network pharmacy with your Shingrix prescription will save you money or reimbursement. A shot administered at the doctor’s office could result in an administration fee.

Will Medicare Cover Shingles Treatment?

Medicare won’t cover the shingles shot. Part B will cover outpatient treatment for shingles such as pain or rash. Medicare Part A will provide inpatient coverage if admitted to the hospital.

Shingles are painful, and if you think you have shingles, you should seek medical attention immediately. Antiviral prescriptions can make the rash less intense — but health professionals recommend starting treatment as soon as possible.

Those with Medigap insurance may pay little to nothing for the cost of their shingles treatment. If you have a Part C policy, you’ll have coverage, but the costs will vary depending on your plan.

FAQs

Why is the Shingles vaccine not covered by Medicare?

There is no 100 percent accurate answer to this question since Medicare hasn’t said why Part A or B enrollment doesn’t help with this immunization. However, Original Medicare tends to cover medically necessary aspects of your health.

The CDC recommends that all 50 and older adults get the shingles vaccine, but it’s not considered a medical necessity. Part C and D of Medicare, which carry premiums, will cover this.

Is Shingrix free for beneficiaries?

The short answer is no — Original Medicare doesn’t cover Shingrix, and you will pay full price. There is a co-pay even if you have Part C or Part D, so the shot carries a cost, even if it’s a reduced one. On the other hand, Medicaid will cover the full cost if you live in a state that’s authorized it.

Do any Medicare Part D plans cover Shingrix?

Yes, many companies that offer Part D plans to their beneficiaries will cover at least some part of the out-of-pocket costs of the shot.

Find Medicare Coverage for Your Shingles Vaccine

Many top Part D companies offer coverage for the shingles vaccine. Companies like Aetna, Cigna, Humana, SilverScript, and WellCare are all known to provide coverage for the shingles shot.

Plans vary across the nation, be sure to verify the policies in your area offer coverage for the shingles shot. An insurance agent is a great resource for finding the most suitable Part D or other Medicare insurance policies.

Call us at the number above or fill out our online rate form for a personalized plan review because you deserve the best coverage. Start your journey now to compare plans online.

Written By:
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Lindsay Malzone, Lindsay Malzone is the Medicare editor for Medigap.com. She's been contributing to many well-known publications since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
Reviewed By:
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Rodolfo Marrero, Rodolfo Marrero is one of the co-founders at Medigap.com. He has been helping consumers find the right coverage since the site was founded in 2013. Rodolfo is a licensed insurance agent that works hand-in-hand with the team to ensure the accuracy of the content.