Does Medicare Cover the Shingles Vaccine?Some Medicare plans cover the shingles vaccine. This article has all you need to know about getting the shot.
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Shingles is a common yet unpleasant disease. It causes painful rashes and blisters and sometimes results in long-lasting nerve issues.
The shingles vaccine can effectively protect you from these symptoms. The cost of the shot may be covered depending on which Medicare plan you have.
Does Medicare Cover Shingles Vaccine (Shingrix)?
The shingles vaccine (Shingrix) is covered by Medicare if you have prescription drug coverage via a Medicare Part D plan or a Medicare Advantage Plan.
The shingles vaccine is not covered by Medicare Part A (Hospital Insurance) or Part B (Medical Insurance), as these plans cover treatment in medical facilities and outpatient treatment.
This is despite the fact that Medicare Part B covers some common vaccines like those for the flu, hepatitis B, and pneumonia.
What about Zostavax?
Zostavax is a shingles vaccine that was discontinued in the U.S. on November 18, 2020. This means Medicare does not cover Zostavax.
How Much Does the Shingles Vaccine Cost?
The list price of the shingles vaccine is $162 per shot. You need two doses for the treatment to be effective, bringing the total cost to $324 if you pay full price.
It’s possible to pay less than this amount due to insurance, discounts, and other subsidies. You will often have to pay part of the fee, even if you have Medicare coverage.
What Is the Cost of the Shingles Vaccine with a Relevant Medicare Plan?
If you have a relevant Medicare plan, the amount you pay for the shot will depend on your plan specifics.
As a ballpark figure, GlaxoSmithKline says that most people with Medicare Part D coverage pay less than $50 per shot and $100 for the entire treatment.
The price will be affected by:
The cost of the vaccine at the location you choose to get it from.
The deductible amount for the type of drug in question.
The amount you have already spent on drugs.
Your copay amount.
The biggest factor is typically your plan’s deductible. This is the amount you must pay for drugs before the medical insurance company contributes.Copay amount vs. deductible
|This is a set fee that insurance companies make you pay for a health service. The exact amount depends on your plan. You typically have to contribute to a copay even if you’ve paid your deductible.||This is the amount you must pay for health service before your insurance plan kicks in. Different types of services have different deductibles.|
Let’s say your deductible amount for Tier 3 drugs like the shingles shot is $500 with a copay of $45.
If you haven’t yet spent $500 on drugs, you’ll have to pay full price for the treatment. If you have reached the limit, you just pay the copay amount for each vaccine.
Some Medicare prescription drug plans don’t have any deductibles. In this case, you can get the cheaper rate no matter how much you have spent on drugs.
Of course, you should check the drug coverage specifics of your plan for further details.
What Is the Cost of the Shingles Vaccine without a Relevant Medicare Plan?
You may be able to save on the retail cost of the treatment even if you don’t have appropriate Medicare coverage.
Here are three options to look into:
The GSK Patient Assistance Program helps people who have spent more than $600 on prescription drugs in a calendar year and meet specific income and related requirements.
State pharmaceutical assistance programs can reduce the cost of the shingles shot if available in your area.
It’s possible to get the vaccine for less than the retail costs by taking advantage of retailer discounts.
Where Can You Get the Shingles Vaccine?
You can get your shingles vaccines at a doctor's office or a pharmacy. Most major chains like Walgreens, CVS pharmacy, or Walmart can administer the shot, as well as some independent pharmacies.
You may need a doctor's note to get the vaccine administered by your pharmacist and have it covered by Medicare. Be sure to check that the location you get the vaccine is part of a pharmacy network covered by your Medicare plan.
If you get the vaccine at your doctor's office, remember that the doctor’s fee can add to the cost. This may lead to you paying more than expected—even with a Medicare prescription drug plan. Be sure to check how this fee affects the cost before getting the vaccine.
Why Get the Shingles Vaccine?
Quite simply, it is an effective way to protect yourself from shingles.
You’re at risk of shingles if you have had chickenpox. The two diseases are caused by the same virus—it stays inactive in the body once you recover from chickenpox, but it can become reactivated years later.
You should consider getting the shot, even if you don’t remember having had chickenpox. The Centers for Disease Control’s website (CDC) says 99% of Americans born before 1980 have had the disease. This means you may have had it even if you don’t think you did.
If you don’t get the vaccine and end up contracting shingles, you’ll typically get painful blisters. These tend to scab over in seven to ten days and clear up in two to four weeks.
The CDC says that around one in ten people who contract shingles also develop postherpetic neuralgia (PHN). This is a nerve issue that can last for months or years, even once all visible signs of the disease have disappeared.
In rare cases, shingles can cause pneumonia, blindness, brain inflammation, hearing problems, and even death.
Who Should Get the Shingles Vaccine?
Shingles is common among those over 50. The CDC recommends that healthy adults over this age get the vaccine.
The recommendation to get the vaccine includes people who:
Have already had shingles.
Have already had Zostavax—a previously recommended version of the shingles vaccine.
Aren’t sure whether or not they had chickenpox.
The CDC recommends that some groups of people should avoid the vaccine.
This includes those who:
Have had a severe allergic reaction to components of the vaccine.
Test negative for immunity to the varicella-zoster virus.
Are pregnant or breastfeeding.
Have a moderate to severe acute illness—including anyone with a temperature of 101.3°F or higher.
Check with your doctor to see whether it is appropriate to get the vaccine.
Can You Get Shingles More than Once?
Most people only suffer from shingles once. But it is possible to get it multiple times. A study that tracked 1,700 shingles patients between 1996 and 2001 found that around 5% of people contracted the disease again within seven years.
The CDC says that getting the shingles vaccine can prevent the disease from recurring. You can get the vaccine once the shingles rash has disappeared.
How Many Times Do You Need to Get the Shingles Vaccine?
The shingles vaccine comes in two shots. These must be separated by a period of two to six months.
The good news is that clinical trials found the vaccine is more than 90% effective at preventing shingles. And the even better news is that protection stays above 85% for at least four years after your vaccination.
Are There Any Side Effects to Be Aware Of?
The CDC says the vaccine is likely to cause temporary side effects that disappear in two to three days. According to the government body, around one in six people feel effects that stop them from doing regular activities. Side effects can occur after either dose.
Potential common side effects include:
A sore arm
Redness and swelling at the shot location
A fever, headaches, shivering
The CDC says that pain medication, including ibuprofen or acetaminophen, can help with this pain.
What If You Don’t Have a Relevant Medicare Plan?
If you have a Medicare Advantage plan with prescription drug coverage or a Medicare Part D plan, your shingles vaccines are covered. Check your plan or contact your insurance provider for detailed information about how to get the shot.
If you don’t have one of the above Medicare plans, you’ll have to pay for the shot yourself or switch to a plan that does cover the cost. It may make sense to do this, depending on your other medical expenses.
You can find out more about switching to Medicare Advantage plans here. If you've already decided to make the switch, you can view and compare Medicare plans here.
Medicare Part D and some Medicare Advantage Plans cover the shingles vaccine.
You aren’t covered if you only have Medicare Part A or Part B.
The amount you pay depends on your plan’s deductibles, copay amount, and the vaccine cost.