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Is the Shingrix Vaccine Covered by Medicare?

Key Takeaways

  • Yes, the shingles vaccine Shingrix is covered under Medicare Part D.
  • Most beneficiaries pay little to no out-of-pocket costs due to recent changes under the Inflation Reduction Act.
  • Shingrix is not covered under Medicare Part A or Medicare Part B.
  • Coverage applies whether you have a standalone Medicare Part D plan or a Medicare Advantage plan with prescription drug coverage.
  • If you’re 50 or older, you may also be eligible to get the shingles vaccine at no cost through Medicaid or private insurance.
  • Two doses of Shingrix are required for full protection.

Which Part of Medicare Covers the Shingles Vaccine?

The Shingrix vaccine is covered under Medicare Part D, which provides prescription drug coverage. This includes:

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  • Standalone Medicare prescription drug plans
  • Medicare Advantage plans (Part C) that include Part D coverage

Original Medicare consists of Medicare Part A and Medicare Part B. Part A generally covers hospital care, and Part B covers outpatient medical services like doctor’s office visits and certain vaccines (such as flu, COVID-19, and hepatitis B for high-risk individuals). However, Medicare Part B does not cover the shingles shot.

Instead, coverage for Shingrix falls under Medicare Part D coverage because it is considered a commercially available adult vaccine administered through a pharmacy or healthcare provider.

How Much Does Shingrix Cost With Medicare?

Thanks to provisions in the Inflation Reduction Act, recommended adult vaccines covered under Medicare Part D are now available with no cost-sharing for most beneficiaries. This includes the vaccines for shingles (Shingrix), Respiratory Syncytial Virus (RSV), whooping cough, tetanus, measles, and more.

That means:

  • No deductible
  • No copay
  • No coinsurance
  • No out-of-pocket costs for the dose of Shingrix

This applies as long as the vaccine is administered by an in-network provider or pharmacy under your Medicare Part D plan.

Before these changes, beneficiaries often had to pay a copay or coinsurance, and costs could exceed $100 per dose. Now, most people with Part D coverage can receive both doses of the shingles vaccine at no cost.

Does Medicare Advantage Cover Shingrix?

Yes. If you are enrolled in a Medicare Advantage plan (Part C) that includes prescription drug coverage, Shingrix is covered under the plan’s Part D benefit.

Coverage rules may vary slightly between insurance plans, so it’s important to:

  • Confirm your plan includes prescription drug coverage
  • Check whether the pharmacy or healthcare provider is in-network
  • Verify billing procedures if receiving the shingles shot in a doctor’s office

You can review plan details during Medicare enrollment periods or by visiting Medicare.gov.

Why Is Shingrix Recommended?

The Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) recommend Shingrix for:

  • Adults ages 50 years and older
  • Adults ages 19 years and older who have weakened immune systems

Shingrix protects against herpes zoster, a viral infection caused by reactivation of the varicella-zoster virus. This is the same virus that causes chickenpox.

Shingles can cause a painful rash with blisters and may lead to postherpetic neuralgia (PHN), a long-lasting nerve pain condition. Older adults and those with weakened immune systems are at higher risk of severe complications.

Because of its effectiveness in preventing shingles and PHN, Shingrix is considered a routine adult vaccine.

Is Zostavax Covered by Medicare?

The older Zostavax vaccine was previously covered under Medicare Part D as well. However, Zostavax is no longer used in the United States. Shingrix replaced it because it provides stronger and longer-lasting protection.

If you previously received Zostavax, the CDC still recommends getting the full two-dose series of Shingrix for better protection.

What If You Have Both Medicare and Medicaid?

If you are dual-eligible for Medicare and Medicaid, your vaccine coverage is generally coordinated through your Medicare prescription drug plan. Because cost-sharing for adult vaccines under Part D has been eliminated, most dual-eligible beneficiaries will not have out-of-pocket costs for Shingrix.

You can confirm details with your healthcare provider, pharmacy, or plan administrator.

Where Can You Get the Shingles Shot?

Shingrix can typically be administered at:

  • Retail or community pharmacies
  • Some doctors’ office locations
  • Clinics that accept Medicare prescription drug coverage

Many pharmacies bill Medicare Part D plans directly, which simplifies the process for beneficiaries.

Be sure to bring your Medicare Part D or Medicare Advantage plan information when receiving your immunization.

What About Side Effects?

Like other adult vaccines, the shingles shot can cause side effects. Common side effects include:

  • Pain at the injection site
  • Fatigue
  • Muscle pain
  • Headache
  • Fever

These symptoms are typically temporary and only last 2 to 3 days. Serious side effects are rare. If you experience severe or bothersome symptoms, contact a healthcare provider.

The Bottom Line

Yes, Medicare covers the Shingrix vaccine under Medicare Part D. Due to recent federal legislation, most beneficiaries pay no deductible, copay, or coinsurance for this shingles vaccine when received through an in-network provider.

If you are unsure about your specific Medicare coverage, check your Medicare Part D plan details, speak with your healthcare provider, or visit Medicare.gov for up-to-date information.

Frequently Asked Questions

Does Medicare Part B cover the shingles vaccine?
No, Medicare Part B does not cover Shingrix. The vaccine is covered under Medicare Part D, which handles prescription drug coverage.

Do I have to pay a copay for Shingrix with Medicare?
Most beneficiaries do not have to pay a copay or coinsurance due to changes under the Inflation Reduction Act. As long as the vaccine is covered under your Part D plan and administered in-network, out-of-pocket costs are typically zero.

Is Shingrix covered under Medicare Advantage plans?
Yes, Medicare Advantage plans that include prescription drug coverage provide Part D coverage for Shingrix. Coverage details may vary slightly depending on your insurance plan.

How many doses of Shingrix does Medicare cover?
Medicare covers both required doses of Shingrix. The second dose is typically given 2 to 6 months after the first dose.

Where can I confirm my Medicare coverage details?
You can review your coverage through your Medicare prescription drug plan documents, contact your plan directly, or visit Medicare.gov for more information.

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