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Does Medicare cover Shingrix?

Cropped SingleCare logo By | January 20, 2020
Medically reviewed by Kristi C. Torres, Pharm.D.

Shingles (herpes zoster) is a viral infection caused by the virus varicella-zoster. It produces a painful rash with blisters and typically shows up on one side of the body. The same virus that causes chickenpox is what causes shingles. Anyone who has had chickenpox in the past is at risk of getting shingles. Shingles can be painful but is preventable by vaccination.

The Centers for Disease Control and Prevention (CDC) recommends that adults over the age of 50 get the shingles vaccine. Shingles can cause long-term pain (postherpetic neuralgia) and nerve damage. Getting a shingles vaccine once, and again two to six months later has been proven very effective at preventing shingles. Shingrix is the most popular shingles vaccine; Zostavax is another available option.

Which vaccine is best for shingles?

Shingles can cause a painful rash with blisters, and some people even experience headaches, chills, fever, and an upset stomach. Many people might not think that they’ll get shingles, but it can cause long-lasting damage and is very painful to experience. The best way to avoid these symptoms is to get a shingles vaccine. Even if you’ve had shingles before, getting vaccinated can help reduce your chances of getting it again.

Zostavax was the first shingles vaccine to be licensed by the FDA in 2006. It’s a live vaccine, which means that it isn’t suitable for people who can’t receive live vaccines, such as those with autoimmune disorders.

These restrictions don’t apply to Shingrix, as it is not a live vaccine. Shingrix has also proven to be more effective than Zostavax, as it covers more strains of the virus, but choosing Shringrix over Zostavax will mean getting two shots instead of one.

Both vaccines protect against shingles for at least five years, though Shingrix could last a little longer. Talking with your doctor is the best way to determine which shingles vaccine is the right choice for you.

Does Medicare cover shingles vaccines?

Most health insurance companies cover shingles vaccines, but standalone Medicare coverage won’t cover the vaccines. You must be enrolled in a Medicare Part D drug plan in order to have prescription drug coverage that covers shingles vaccines. A Medicare Part A (hospital insurance) plan or Medicare Part B (medical insurance) plan, components of original Medicare, won’t give you the right amount of coverage.

You can enroll in a Medicare Part D prescription drug plan by itself, or enroll in a Medicare Advantage Plan that includes Part D coverage. Either of these options will cover Shingrix and Zostavax, the two shingles vaccines on the market.

Every Medicare Part D plan is different and will provide varying degrees of coverage for shingles vaccines. Some plans may have better coverage with lower copayments, and some may have worse coverage with higher copays. It’s also possible that you may have a deductible, copay, or coinsurance.

Different Medicare Part D plans classify medications and vaccinations into different tiers. What tier your plan puts shingles vaccinations into will determine your copay. The best way to determine which insurance plan is best for you is to talk with a Medicare services advisor.

Medicare.gov is also a helpful resource for comparing Medicare prescription drug plans, searching for providers and facilities, and for estimating potential costs. TTY users can call 877-486-2048 to talk to a Medicare representative.

Which vaccines does Medicare cover?

Medicare covers a variety of vaccines. While Medicare Part B is generally known to cover most vaccines, Part D typically covers any vaccines that a Part B plan doesn’t. Here’s a table to help clarify which vaccines are covered by each plan:

Medicare Part B  Medicare Part D
Hepatitis B vaccines MMR vaccines
Influenza virus vaccines Tdap vaccines
Pneumococcal pneumonia vaccines Shingles vaccines
Vaccines related to treating an injury or exposure to a disease All other commercially available vaccines not covered by Medicare Part B

To learn whether or not your Medicare plan covers the vaccine you need, you should check your plan’s formulary. A formulary is a list of all the prescription drugs that your plan covers and how much they might cost you. Call your insurance company or insurance agency to learn more about your particular plan’s formulary.

How much does the shingles vaccine cost?

Shingles vaccines can be costly, costing up to $300 per dose. Having insurance may drop the price of a shingles vaccine, but prices will depend on the insurance carrier and any deductibles, copays, or coinsurance. Here’s a table to help compare the cost of Shingrix and Zostavax, the two shingles vaccines available for purchase:

Shingrix Zostavax
Retail price (without insurance) $181.99 $278.00
Covered by insurance? Yes Yes
Covered by original Medicare? No No
SingleCare coupon Get Coupon Here Get Coupon Here

Why is the shingles vaccine so expensive?

“It is important to remember that bringing vaccines to market can cost $1 billion and take decades to develop,” Amesh Adalja, MD, a board-certified infectious disease physician and senior scholar at the John Hopkins Center for Health Security. “The burden of shingles and its after-effects are sizable, so it is important that the few companies that manufacture the vaccine have market incentives to continue to make vaccines. The demand for Shingrix is very high, with shortages occurring, so the price has not been a barrier to its uptake.”

Enrolling in a program that covers shingles vaccines is the best way to save money. Medicare parts A (Hospital Insurance) or B (Medical Insurance) do not cover shingles vaccines, but Medicare Part D plans do. The amount of coverage, copay, and deductibles that someone will have to pay as part of a Medicare Part D plan varies. Without health insurance, many people might not be able to afford their shingles vaccines.

How to get a shingles vaccine covered by Medicare

Once you have an insurance plan that covers shingles vaccines, purchasing them is the next step. Many pharmacies that provide vaccines do so under the standing order of a supervising physician. This is convenient for patients because it saves them a trip to the doctor’s office to acquire a prescription first for the vaccine.

Remember, only a pharmacy can bill Medicare Part D for your vaccine and provide you the best coverage, so in order to get the best price, you will want to get your vaccine in a pharmacy. If your pharmacy of choice does not have standing orders for the shingles vaccine, then you will want to visit your physician first to acquire a prescription.

It’s possible to save money on shingles vaccines with a SingleCare pharmacy savings card. SingleCare can help uninsured or underinsured patients get shingles vaccines at a discounted price.