Shingles can cause intense pain and discomfort, but the good news is that it can be preventable with the Shingrix vaccine. If you’re wondering whether your Medicare plan covers this vaccine, you’re not alone. As licensed agents who specialize in Medicare, we hear this question a lot. In this post, we’ll break down how Medicare covers the shingles vaccine, recent changes to the coverage, associated costs and what you need to know to stay protected.
Who Should Get the Shingles Vaccine?
According to the Centers for Disease Control and Prevention (CDC), adults aged 50 and older should receive two doses of the Shingrix vaccine, spaced 2 to 6 months apart, to prevent shingles and its complications. Additionally, adults aged 19 and older with weakened immune systems due to disease or therapy are advised to get the shingles vaccine.
Learn More From the CDC on the Shingle Vaccine
Does Medicare Cover the Shingles Vaccine?
Original Medicare does NOT cover the shingles vaccine. If you are enrolled in a stand-alone Part D drug plan (PDP) or a Medicare Advantage plan with Part D coverage (MAPD), then your Medicare does cover the shingles vaccine.
Medicare Vaccine Guidelines:
Medicare Part D: This part of Medicare covers the shingles shot. By enrolling into a Part D plan, you have the benefit built in.
Medicare Part B: This part of Medicare does NOT cover the Shingles vaccination, but it does cover the flu, pneumonia, and hepatitis B shot.
Find out more about Part B vs. Part D Medicare Drug Coverage
Shingles Vaccine Costs
In the past, the shingles vaccine was covered by Medicare plans differently than now. Previous to 2023, Medicare Part D did cover the shingles vaccine. However, it typically was in a higher tier for most Medicare plans, and as a result, oftentimes, Medicare beneficiaries were responsible for paying deductibles and copayments for the vaccine. If the Part D plan deductible had not already been met, then individuals would find themselves paying several hundred dollars to receive the two-part shingles vaccine. The change on the shingles vaccine coverage was made under the Inflation Reduction Act (IRA), which eliminated out-of-pocket expenses for vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP).
Because of the changes made, the shingles vaccine is now covered with no out-of-pocket costs for Medicare recipients who are enrolled in a Medicare plan with Part D coverage.
Find out more about vaccines that are covered by Medicare in our blog: Understanding Medicare Vaccine Coverage: What’s Included, from Flu to RSV
Where to Get the Shingles Vaccine
You can receive the shingles vaccine at either a pharmacy or a doctor’s office. If you go to a pharmacy, you'll want to make sure it’s part of your plan’s network. When getting the vaccine at a doctor’s office, verify that they can process claims through Medicare Part D. If you receive the vaccine at a doctor’s office that isn’t in-network, you may have to pay for the vaccine upfront and then file a claim for reimbursement.
If you have questions about how your Medicare coverage covers the shingles vaccine or other vaccines, our team at Twin City Underwriters would be happy to answer them. Reach out today to talk to a Medicare professional.
This is an updated blog that was originally published in 2018.
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