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En español | Unlike some common vaccines, like those for the flu, hepatitis B and pneumonia, shingles shots are not covered under Medicare Part B, the component of original Medicare that includes doctor visits and outpatient services. Part A, which deals with hospital costs, doesn’t cover shingles shots either.
Medicare coverage for Shingrix and Zostavax, the two commercially available shingles vaccines, is provided only if you are enrolled in a stand-alone Part D drug plan or a Medicare Advantage plan that includes Part D drug coverage.
Medicare requires Part D plans to cover the shingles vaccine, so if you’re enrolled in Part D, you shouldn’t have difficulty obtaining the shot. Most require a copayment, which can vary widely from plan to plan.
And if you haven’t yet met your plan’s deductible for the year, you’ll likely pay the full price. For Shingrix, the newer vaccine, that averages around $190, according to GoodRx, a website and app that tracks prescription prices.
• At the pharmacy. You’ll still need a doctor’s prescription, but once that’s been transmitted, you can get the shot at a retail pharmacy.
Most major chains and some independent pharmacies can administer the vaccine. Just make sure to use a store in your drug plan’s network so that it can bill your plan directly and you’ll owe just the copayment.
• At the doctor’s office. If you’re vaccinated in a doctor’s office, check whether it can bill your drug plan directly or works with a pharmacy that can do so. If so, it will work as mentioned above, with you owing a copayment. If not, you may need to pay the full cost up front and then file a claim for reimbursement from your plan.
Remember that the doctor’s fee for administering the vaccine may exceed your plan’s allowable charge, in which you case you’re on the hook for the difference. It pays to check beforehand.
Editor's note: This article was originally published on Jan. 1, 2014. It has been updated with the latest information regarding Medicare coverage in 2020.
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