Does Medicare Cover Shingles Vaccine?
Yes, Medicare covers the shingles vaccine if you have a Medicare Part D or a Medicare Advantage plan with drug coverage. Unfortunately, Original Medicare (Part A and Part B) does not offer any coverage.
As of 2023, the two-dose shingles vaccine is available with zero out-of-pocket costs with the appropriate Medicare plans. The factors that influence whether Medicare pays for the shingles vaccine depend on the following:
- Whether you’re 65 or older or are otherwise eligible for Medicare
- Whether you have Part D coverage
- Whether you have a Medicare Advantage (Part C) plan with prescription drug coverage
Before 2023, Medicare enrollees had to pay a copay and deductible for the shingles shot, even if covered by Medicare Part D or Part C. Now, you can get the shot with zero copay or have to pay toward your deductible due to the 2022 Inflation Reduction Act.
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What are Shingles?
Anyone with a history of chickenpox is at risk of shingles. The chickenpox virus stays dormant in your body and can reactivate as you age, which causes shingles (also known as herpes zoster). Around 1 million American adults get shingles annually. Your risk of shingles and severe side effects increases with age as your immune system decreases naturally.
Shingles is very uncomfortable, causing the following symptoms:
- Painful blister-like sores
The body may take 2-4 weeks to clear a shingles viral infection. In a worst-case scenario, shingles can lead to pneumonia, blindness, brain inflammation, or even death. A more common shingles complication is postherpetic neuralgia (PHN), long-term nerve pain impacting up to 18% of people who get shingles.
How Does Medicare Coverage of the Shingles Vaccine Work?
Medicare is intended to provide essential health services for adults 65 and older, and Medicare Part B often covers vaccines. However, shingles is unfortunately not yet covered by Part B. You must have Medicare Part D or Part C to have coverage.
Who Can Get the Shingles Vaccine Covered By Medicare?
Once you are eligible for Medicare, you can get Medicare Part C or Medicare Part D, which pays for the shingles vaccine. To be eligible for Medicare, you must:
- Be 65 or older
- Have permanent kidney failure requiring dialysis or a transplant, also known as end-stage renal disease.
- Have Lou Gehrig’s disease or amyotrophic lateral sclerosis (ALS)
Which Shingles Vaccine is Available Through Medicare?
Medicare beneficiaries are given the Shingrix vaccine. Before 2020, they would likely have been given Zostavax, another shingles vaccine. However, studies showed that Zostavax’s effectiveness decreased rapidly after use, particularly for older adults. For example, Zostavax only had an efficacy of 18% for adults aged 80 and older. Zostavax is no longer available in the U.S.
Now, Medicare enrollees will get the Shingrix vaccine, which is more effective for longer. The Food and Drug Administration (FDA) approved Shingrix for those 50 and older in 2017 and expanded approval to those 18 and older with immunodeficiency or disease- or therapy-caused immunosuppression.
Which Medicare Part Covers The Shingles Vaccine?
Medicare is divided into four major parts. Medicare Part C and Part D are the two parts that offer coverage for the shingles vaccine.
- Medicare Part A: This part covers inpatient hospital care and is offered by the U.S. government. It does not cover vaccines.
- Medicare Part B: This part covers most preventive and doctors’ services, but not shingles vaccines.
- Medicare Part C: Also known as Medicare Advantage, Part C may cover the shingles vaccine. Part C plans typically combine Part A, Part B, and Part D care and extra benefits. However, not all plans offer drug coverage, so you should review your policy for details.
- Medicare Part D: Part D covers your prescription drugs and recommended vaccines and is offered by private insurance companies. It does cover the shingles vaccine.
How Much Does It Cost To Get the Shingles Vaccine Through Medicare?
If you do not have drug coverage through Medicare or another health plan (which typically covers most of the costs), the two-dose shot is $366.82. However, those with Part D drug coverage will not pay anything for a shingles vaccine as of 2023. Part D comes with monthly premiums that vary based on your plan and income and can change yearly. It’s estimated that the monthly premium for Part D in 2024 will be around $55.50.
Medicare Advantage plans with prescription drug coverage also cover the vaccine. Review your Explanation of Benefits (EOB) to ensure Shingrix is covered or if there are any rules around full coverage — for example, only getting the shot at an in-network clinic.
If you do not have Part D drug coverage or a Medicare Advantage plan that covers the shingles vaccine, you have a few options:
- Pay for the vaccine out of pocket
- Apply for Medicare Extra Help
- Apply for the GSKForYou program’s help paying shingles vaccine costs
- Apply for Medicaid, which reduces Shingrix costs to as little as $5 per dose in two-thirds of states for those 50 years and older
How To Get a Shingles Vaccine Covered By Medicare At No Cost
If you have Original Medicare, the best way to get a free shingles vaccine is by enrolling in Medicare Part D or a Medicare Advantage plan with prescription drug coverage. Here’s how.
- Compare Part D Plans. Compare plans by cost and formulary, the list of the drugs covered by the plan. Ensure Shingrix is on the list.
- Select a Plan. Choose the plan that’s best for you overall, including coverage of any existing medications and affordability. Review how the drug plan works with any of your current coverage.
- Enroll in a Plan. You can enroll online by calling the plan or using a paper form. If you do not enroll within your Initial Enrollment Period (IEP) or go for two months without coverage, you may need to pay a late enrollment penalty.
- Pay the Premium. Your premium is the monthly amount you pay to be part of the Part D or Medicare Advantage plan, depending on your monthly income. To get your free shingles vaccine, check online or with the insurance company to ensure your plan is active.
Who Should and Should Not Get the Vaccine?
The Centers for Disease Control (CDC) recommends two Shingrix doses for adults 50 years and older. You should get the vaccine if, in the past, you:
- Had chickenpox or cannot remember if you have had it
- Had shingles
- Received the chickenpox vaccine more than 8 weeks ago
- Received Zostavax, a discontinued shingles vaccine, more than 5 years ago
- Have immune system issues
You should not get the vaccine right now if you:
- Had a severe allergic reaction to Shingrix or another Shingrix vaccine component
- Currently have a severe case of shingles
- Are you taking antiviral medications
- Have a moderate or severe illness
- Are pregnant
If you fall into any of these categories, speak with your physician about a safer time to get vaccinated.
How Often Do You Need To Get Vaccinated?
The two Shingrix doses are separated by 2-6 months between injections. If you’re an immunocompromised adult, ask your doctor if you can finish the two-dose series within 1-2 months to reduce your risk of shingles.
After completing two-dose vaccination with Shingrix, the effects can stay strong for up to 7 years, depending on your age and immune system. Here’s how effective the vaccine is:
Adults with weakened immune system
68% to 91%
Adults 50 to 59 years
Ages 60 to 69 years
Ages 70 years and older
If you received the less-effective shingles vaccine, Zostavax, in the past, you might be eligible to get the new vaccine now. Discuss your options with your doctor.
Can You Still Get Shingles After Vaccination?
It is possible to get shingles after vaccination. Although vaccination reduces your chances of developing shingles, no vaccine provides 100% protection. Indeed, all vaccines wane over time, leaving you more exposed.
But even previous versions of the shingles vaccine reduced the duration of painful symptoms among those who got shingles post-vaccination. For example, it shortened symptomatic days from 22 to 20. Previous versions also reduced PHN, the nerve pain associated with shingles. Shingrix prevents PHN in 91% of adults aged 50 to 69 and 89% of adults 70 and older.
Even if you’ve already had shingles in the past, it’s wise to get vaccinated to help prevent future outbreaks.
Does The Vaccine Have Any Side Effects?
In clinical trials before the vaccine was released to the public, Shingrix was not associated with serious side effects. Minor side effects included discomfort that faded after a few days, which is possible after both doses or just the first or second dose. Over-the-counter pain relievers such as ibuprofen or acetaminophen can help address many of these issues.
Mild and common effects (more often reported in younger adults) include:
- Redness and sore arm with mild or moderate pain at the injection site
- Muscle pain
- Stomach pain and nausea
More severe side effects can happen with any vaccine and stem from an allergic reaction to the vaccine. These typically occur shortly after vaccination — within minutes or hours:
- Face and throat swelling
- Difficulty breathing
- Fast heartbeat
- Dizziness or weakness
For this reason, your clinic will likely ask you to stay nearby for a short period after receiving the vaccine.
Putting It All Together
If you’re an older adult with Medicare with a prescription drug plan, getting the shingles vaccine could prevent weeks of pain and potentially severe complications. Thanks to changes in 2023, you can get a new, more effective vaccine without any copay or deductible.
Even if you’ve already had shingles or been vaccinated in the past with the less-effective version, you may also qualify for the newer Shingrix. Although some mild side effects have been reported, discomfort typically lasts for a few days — not weeks, as with shingles.
Weigh the risks and benefits of the shingles vaccinations with your physician, and ensure you follow your plan’s rules for receiving a vaccine.