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Does Medicare cover the shingles vaccine in 2022?

En español | No and yes. Medicare’s Part A and Part B don’t cover shingles vaccinations, even though the Centers for Disease Control and Prevention (CDC) recommends that everyone age 50 and older get the vaccine. Medicare Part B covers some other vaccines as free preventive care, such as the flu and pneumonia vaccines.

With that said, Medicare Part D covers the shingles vaccine, as do private Medicare Advantage plans that include drug coverage. These plans must cover all commercially available vaccines needed to prevent illness, except for those that Part B covers. 

In the United States, about 1 in every 3 people are at risk for shingles or herpes zoster, the same virus strain that causes chicken pox. If you’ve had chicken pox, the virus stays dormant in your system and may reappear as shingles later in life, which is why the vaccine is recommended. 

How much is a shingles shot under Medicare Part D? 

The good news is that the cost of a shingles vaccine, which comes in two timed doses, is subject to change in 2023. 

Starting in 2023, the Inflation Reduction Act will eliminate all out-of-pocket costs for vaccines that the CDC’s Advisory Committee on Immunization Practices recommends for adults. That includes the shingles vaccine. 

However, in 2022 you may be charged a copayment for the shingles vaccine. This varies from plan to plan. The average Part D copayment for vaccines was $47 in 2020, according to Avalere Health, a health care consulting firm.

If you haven’t yet met your plan’s annual Part D deductible, which can be up to $480 in 2022, you may have to pay more for the shot. Shingrix, a vaccine the Food and Drug Administration approved in 2017, runs around $212 per dose. 

It replaced Zostavax in November 2020. But even if you received Zostavax before it was retired, the CDC recommends getting inoculated with Shingrix: two doses for adults 50 and older spaced two to six months apart.

How can I get a shingles vaccine? 

While most people get their shingles shots at a pharmacy, some receive it at their doctor’s office. At one time, some states required a prescription to get the shingles vaccine at a pharmacy, but those states have recently changed their rules. Now you don’t need a prescription to get the shingles vaccine.

At a pharmacy. Pharmacists in all states can administer vaccines included on the CDC-recommended adult immunization schedule, including the shingles vaccine. Make sure your pharmacy is in your Part D plan’s network so it can bill your plan directly. Check with your pharmacy and insurance plan for details.

At a doctor’s office. It’s a good idea to confirm your doctor can bill Medicare Part D before you plan to get the vaccine there. Otherwise, you may need to pay for the vaccine and submit a claim for reimbursement to your Part D plan. Ask the doctor’s office and your plan about the rules. 

Keep in mind 

If you have trouble affording Part D prescription drug coverage, you may qualify for the Extra Help program, a government program that helps people with limited income and assets pay premiums and out-of-pocket costs for Part D drug coverage. Starting in 2024, the Inflation Reduction Act also expands the level of income eligibility for the Extra Help program. 

Update October 11, 2022

     

        


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