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I had a friend get shingles, and it was awful.
Now that I’ve seen it first-hand, I definitely want to get the vaccine. But I’ve heard that Medicare does not cover it. Is that true? Or does Medicare cover the shingles vaccine?
Scared of shingles,
Gail from Belle Isle, Florida
We’re so sorry to hear that your friend had shingles. Sometimes it takes seeing something first-hand or helping someone through a health scare to realize we need to take action.
The Centers for Disease Control and Prevention (CDC) recommends that adults 50 years and older get the shingles vaccine.
Shingles is a viral infection caused by the same virus strain that manifests as chicken pox. This means that if you’ve ever had chickenpox, you are at a higher risk of getting shingles as you age. In fact, one in every three people is at risk for shingles or herpes zoster. And there are serious complications.
Between 10% to 18% of people who get shingles will experience postherpetic neuralgia (PHN), which is severe pain in the areas where the shingles rash occurs.
“Starting January 1, 2023, you will not have any out-of-pocket Medicare costs for the shingles vaccine.“
Older people and those with a weakened immune system could be hospitalized from complications. About 1% to 4% of people who get shingles are hospitalized because of PHN. There are fewer than 100 deaths per year from shingles and complications, and those who are immunocompromised are at the highest risk.
The Shingrix shingles vaccine is in two doses, separated by two to six months. The Shingrix vaccine is 90% effective after you’ve had both shots.
Shingrix replaced Zostavax in November 2020. If you know someone who had the Zostavax immunization, it’s recommended that they get revaccinated – with the Shingrix vaccine.
Does Medicare cover the shingles vaccine? Yes, and no. Currently, Original Medicare Part A and Medicare Part B do not cover the shingles vaccine.
Medicare Part D prescription drug plans may cover the shingles vaccine. This includes prescription drug coverage received through Medicare Part D plans or a Medicare Advantage Prescription Drug plan (MA-PD).
When adults choose whether they get their shingles shot at the doctor’s office or a pharmacy, 95% of Medicare Part D enrollees receive the shingles vaccine (Shingrix) at a pharmacy, that’s because most doctor’s offices cannot bill vaccinations for Part D enrollees.
The shingles vaccine copayment in 2022 is about $50 per dose of Shingrix, or $100 to be fully inoculated (two doses). If you want your doctor to administer your Shingrix vaccine, you should first ask if they can bill your Part D plan before the vaccination. Otherwise, you may need to pay out-of-pocket, costing $343.13 or $171.57 per dose or more. You should check with your plan for exact copayment and out-of-pocket costs.
There is good news starting January 1, 2023. The Inflation Reduction Act will eliminate all out-of-pocket vaccine costs recommended by the CDC’s Advisory Committee on Immunization Practices, including the shingles vaccine. You will not have any out-of-pocket costs for the shingles vaccine starting January 1, 2023.
I hope this information helps you better understand shingles, the vaccine, and how Medicare covers it. While your prescription drug benefit covers the shingles vaccine today, in 2023, it will be at no cost. No matter your plan, you’ll pay no deductible, copay, or other charges for a shingles vaccine.
At Connie Health, we help you throughout your Medicare journey. If you have additional coverage questions, contact a local licensed Connie Health agent at (623) 223-8884 (TTY: 711). We’d be happy to help.
Last updated: February 23, 2023
Yes, Medicare Part D prescription drug plans may cover the Shingrix shingles vaccine. This includes prescription drug coverage received through Medicare Part D plans or a Medicare Advantage Prescription Drug plan (MA-PD). This is effective as of January 1, 2023, thanks to the Inflation Reduction Act.
Yes, the Inflation Reduction Act eliminated all out-of-pocket vaccine costs recommended by the CDC’s Advisory Committee on Immunization Practices. This included the Shingrix shingles vaccine. As of January 1, 2023, there are no out-of-pocket Medicare costs for the shingles vaccine.
Yes, Medicare covers the Shingrix shingles vaccine received at CVS. In 2022, 95% of Medicare Part D and Medicare Advantage Prescription Drug plan enrollees received the shingles vaccine at a pharmacy.
Read more by William Revuelta
I am a Spanish-speaking Florida Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2009. I’m an avid sports fan and enjoy watching international soccer matches and college football. When not with my family, I listen to podcasts ranging from history to sports talk.