Will Medicare Cover the Shingles Vaccine for Seniors?

If you know anyone that has had shingles then you know how painful it can be. The last thing we want in our senior years is a disease that is preventable. Shingles is just that – preventable!

If you have ever had chickenpox, you are at risk for Shingles. Luckily, there are vaccinations available to help us prevent this painful ailment. Just as important is what does the Shingles vaccination cost and does Medicare pay for the Shingles vaccine?

When Should You Get a Shingles Vaccine?

The CDC recommends that anyone over the age of 60 should be vaccinated for shingles. The risk of shingles and postherpetic neuralgia (PHN) will increase the older you get. The sooner you are vaccinated the better.

Does Medicare Cover the Shingles Vaccine?

The good news is “yes,” Medicare does cover the shingles vaccination for beneficiaries! However, the vaccine is not covered under Original Medicare Parts A and B as you may have thought. Rather, the shingles vaccine is covered under Medicare Part D, which is the prescription drug aspect of Medicare. All Medicare drug plans are required to provide coverage for the shingles vaccine.

Unfortunately, although all Part D plans are required to cover the Shingles vaccination, they are not required to provide the vaccine at no-cost for enrollees. The vaccine will fall into a tier on the medication formulary, which will most likely require a coinsurance. Typically the two most popular Shingles vaccines, Shingrix and Zostavax will be classified as either a Tier 3 or Tier 4 medication on your Part D plan.

What exactly does this mean for your cost? Well, that all depends on how you have used your Part D prescription drug plan throughout the calendar year. Most Part D plans will have an annual deductible, which maxes out at $445 in 2021 (the deductible may be lower based on your plan). If you have not yet met your annual deductible, you will unfortunatley be responsible for most, if not all of the Shingles vaccination shot cost. The vaccine cost is typically between $150-250. The cost will depend on which vaccine, Shingrix vs Zostavax, as well as the cost at your preferred pharmacy.

If you have met your annual drug deductible for the year, the cost of your Shingles vaccine will depend on the coinsurance amount for either a Tier 3 or Tier 4 medication, based on where the vaccine falls for your specific Part D plan. The coinsurance will either be a set dollar amount, or a percentage of the retail cost.

Does Medicare Cover the Shingles Vaccine?

Yes, the Shingles vaccine is covered by Medicare. All Medicare Part D plans are required to have coverage for beneficiaries to receive a Shingles vaccination. The vaccine, however, is not free under Medicare. You will still pay a coinsurance, copayment, or portion of your deductible to cover the cost of the vaccination.

Will Medicare Pay for the Shingles Vaccine?

Medicare covers the Shingles vaccine under Medicare Part D, which is your drug coverage. This means that no, Medicare does not pay for the entire cost of your Shingles vaccination. Rather, your Part D Drug Plan will provide a level of coverage for the vaccine, but you will still likely pay either a portion of your deductible, or a copayment/ coinsurance.

Where Can I Get the Shingles Shot with Medicare?

Since the Shingles vaccine is covered under Medicare Part D, you will want to get your Shingles shot at a preferred pharmacy under your prescription drug plan. You do NOT want to get your Shingles shot at your primary care doctor, as the office bills Medicare Part B and not Medicare Part D.

It's important to understand that it's best to get your Shingles shot at a preferred pharmacy and not at the doctors office. A doctors office generally cannot bill your Medicare drug plan.

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Where to go for Your Shingles Vaccine?

In order for it to be covered under you Medicare Part D drug plan you will need to get the shot at a network pharmacy. It is important to review your Part D plan benefits to be sure you are using a preferred pharmacy for your vaccination for the lowest cost possible. Surprisingly, you would not want to have it done in the doctors office as they are not able to bill a Medicare drug plan. Seems a little silly right? Either way, it is important to get this vaccination in order to prevent contracting Shingles and save yourself from some unnecessary pain!

How To Treat Shingles

Although Medicare does cover the Shingles vaccine under Medicare Part D, there is still a chance of contracting Shingles before you are able to get your shot. If you are diagnosed with Shingles, there are a few ways to help treat it-

Antiviral Medications

Shingles is a viral infection that causes a painful rash. The Center for Disease Control (CDC) recommends taking antiviral medications such as acyclovir, valacyclovir, and famciclovir to help shorten both the length and severity of Shingles. It is important to begin this type of medication as soon as the Shingles rash appears for the antivirals to be most effective.

Pain Relief

The CDC also recommends different forms of pain relief to fight the significant pain of the Shingles rash. The pain relief options include prescribed and over-the-counter pain medications, as well as wet compresses, calamine lotion, and colloidal oatmeal baths to help relieve any itching.