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En español | Yes, if you have prescription drug coverage.
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 flu and pneumonia vaccines
A prescription drug plan, such as Medicare Part D bought as an add-on to original Medicare or that is part of a Medicare Advantage plan that provides drug coverage, will pay for the shingles vaccine. These private plans must cover all commercially available vaccines needed to prevent illness, except for those that Part B covers.
You’re probably carrying a dormant version of the virus that causes shingles right now. In the United States, more than 99 percent of people born before 1980 have had chicken pox, even if they don’t remember being ill, according to the CDC.
A vaccine to prevent chicken pox first became available in this country in 1995. After you’ve had chicken pox, the varicella zoster virus that causes it may reappear as shingles later in life, which is why the shingles vaccine is recommended.
If you are age 50 to 69, two doses of the Shingrix vaccine are 97 percent effective in preventing shingles. If you’re 70 or older, they are 91 percent effective.
The CDC has no maximum age limit on getting vaccinated against shingles. About 1 in 3 people will get shingles in their lifetimes, and in rare instances it can recur.
If you get shingles, a painful and itchy rash, you can give chicken pox to those who have not had it nor been vaccinated. Then they become at risk for shingles as an older adult.
The cost of a shingles vaccine was reduced in 2023. In the past, you may have been charged a copayment.
But starting in 2023, the Inflation Reduction Act eliminated all out-of-pocket costs for vaccines that the CDC’s Advisory Committee on Immunization Practices recommends for adults, whether you have drug coverage from Part D or from a Medicare Advantage plan. That includes the shingles vaccine.
Without prescription drug coverage, you may have to pay more than $180 a dose for Shingrix, a vaccine the Food and Drug Administration approved in 2017.
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.
Most people get their shingles shots at a pharmacy, and 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 recently changed their rules to allow the vaccine without a doctor’s order.
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. Confirm that 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.
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.
Updated January 4, 2023
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