Does Medicare cover shingles vaccines?

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

“Shingles is a painful rash that occurs along the distribution of a nerve, called a dermatome,” says Erum N. Ilyas, MD, a fellow of the American Academy of Dermatology and founder of AmberNoon. “The virus lays dormant in the nervous system. Immunity likely plays a role in preventing the virus from reactivating. When immunity is low, the virus replicates and spreads down the nerve, causing pain, inflammation, and blistering.”

The Centers for Disease Control and Prevention (CDC) recommends that adults older than 50 get the shingles vaccine. Shingles can cause long-term nerve pain (postherpetic neuralgia) and nerve damage. Getting two shingles vaccine doses two to six months apart has proven to be very effective at preventing shingles.

Shingrix is a brand-name shingles vaccine and is currently the only shingles vaccine available in the United States. Zostavax, a previous zoster vaccine, was discontinued in 2020.

RELATED: Get Shingrix coupons | What is Shingrix?

Does Medicare cover shingles vaccines?

Most health insurance companies cover shingles vaccines, and so does Medicare. However, Original Medicare (Parts A and B) coverage won’t cover the vaccines. You must be enrolled in a Medicare Part D drug plan or a Medicare Advantage Plan that includes drug coverage in order to have prescription drug coverage that covers shingles vaccines. Medicare Part A (inpatient hospital insurance) or Medicare Part B (outpatient medical insurance), components of Original Medicare, won’t cover shingles vaccines.

Other Medicare supplement plans, like Medigaps, don’t cover shingles vaccines either.

You can enroll in a Medicare Part D prescription drug plan by itself or enroll in a Medicare Advantage plan (Part C) that includes Part A, B, and D coverage. Either of these options will usually cover the Shingrix vaccine.

Every Medicare Part D plan is different, and copays or coinsurance may vary from plan to plan. Deductibles also may apply. 

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 the insurance plan that’s best for you is to compare formularies to find the one that covers as many of your medications and vaccinations as possible or contact Medicare customer support.

Medicare.gov is a helpful resource for comparing Medicare prescription drug plans, searching for providers and facilities, and estimating potential costs. TTY users can call 877-486-2048 to talk to a Medicare representative. If you are eligible but don’t have Medicare Part D, you can enroll during open enrollment. You have the opportunity to change plans annually to get a plan that works best for you.

Do I need a prescription for a shingles vaccine?

Once you have a Medicare insurance plan that covers the shingles vaccine, you’ll need to find out whether a prescription is necessary. This is dependent on where you get vaccinated. You won’t need a prescription if you get vaccinated at your doctor’s office.

Some 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 before receiving the vaccine. You may need to call your pharmacy to see how they handle shingles vaccine orders.

If your pharmacy requires a prescription, you’ll need to contact your medical provider first. They may want to see you in the office beforehand, but not always. Sometimes, the doctor may give you the shingles vaccine at your appointment.

Once you have the prescription in your possession, the remaining steps are pretty straightforward. Take the prescription to a pharmacy in your plan’s network to be filled. A pharmacist will administer the vaccine in their clinic area.

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

How much does the shingles vaccine cost with Medicare?

Shingles vaccines can be expensive, costing up to $300 per dose without insurance. Having Medicare Part D may help you avoid paying full price, but your out-of-pocket cost will depend on the plan and its deductibles, copays, or coinsurance.

While coverage and cost may vary and are subject to change, the cost of the shingles vaccine with Medicare Part D is free, according to GSK. 

Another cost factor is where you get vaccinated. People who choose an in-network pharmacy or a doctor’s office that coordinates with or can bill their Part D plan directly will pay less. If your doctor’s office does not coordinate with or bill Part D plans directly, you may be billed for the entire cost of the shingles shot and have to seek reimbursement from your plan later. Reimbursements may not equal the total amount you paid in advance.

Other insurance plans, including private insurance and Medicaid, may cover the shingles vaccine with no out-of-pocket costs. Contact your insurance company for more information and coverage details.

How to get a Shingrix discount without Medicare

There are a few different ways to receive a discount on the Shingrix vaccine. SingleCare’s prescription discount card provides instant savings on many prescription drugs, including Shingrix. Medicare recipients cannot use SingleCare and Medicare coverage together, but they can choose to use whichever offers a better deal for them. For those who don’t have a Medicare plan that covers Shingrix, SingleCare can provide a discount.

GSK, the manufacturer of Shingrix, offers a patient assistance program for those who don’t have insurance coverage. However, there are income guidelines and other eligibility requirements in order to qualify. Those who are enrolled in a Medicare Part D prescription drug plan may still be eligible for the program if their income falls below a certain threshold and they’ve spent at least $505 on prescription medications through their plan during the current calendar year.

Lastly, you may qualify for financial assistance through a Medicare program called Extra Help. Extra Help can help Part D consumers lower their Medicare-related costs.

Learn more about Shingrix

What is shingles, and how do you catch it?

Shingles is a painful skin rash that forms on one side of the body. It is caused by the same virus that causes chickenpox, the varicella-zoster virus. Shingles can affect people who have had chickenpox, even if they had the illness long ago.

Once you’ve had chickenpox, the virus becomes inactive in the body and can reactivate years later. The virus can remain inactive in your nerve roots for many years and then wake up and travel down the path of a sensory nerve to the skin—causing shingles. You may develop shingles more than once in your lifetime.

RELATED: Shingles treatments and medications

Who should get a shingles vaccine?

Shingrix is FDA approved to prevent shingles in people ages 50 years and older. Shingrix helps protect against the risk of getting shingles and reduces the risk of getting postherpetic neuralgia (PHN), which causes long-term nerve pain after an attack of shingles.

How many Shingrix doses do you need?

Shingrix is a two-dose vaccination series. You should get your second shot two to six months after your first shot. However, according to the CDC, the vaccination series does not need to be restarted if you pass the six-month window.

How long does Shingrix last?

The Shingrix vaccine can remain effective for at least four years in most people and even longer in others. You must get the entire series to be protected against shingles, which includes two separate shots. Even if you have had the infection, getting vaccinated can still offer benefits because it may help reduce the risk of developing PHN.

Shingrix may not protect everyone, but it provides broader protection for older adults whose immune systems are declining with age or disease.

Can you take Tylenol before or after shingles vaccines?

Yes, you can take Tylenol (acetaminophen) before or after the shingles vaccine. You should not take aspirin before or after the vaccine because of the increased bleeding risk.

What are the side effects of Shingrix?

The most common side effects include pain and inflammation at the injection site, headache, muscle pain, fatigue, stomach discomfort, fever, and shivering, according to GSK.

Allergic reactions are less common but still possible. Watch for signs of an allergic reaction, such as hives, swelling of the face or throat, trouble breathing, rapid heartbeat, dizziness, and weakness. This is considered an emergency, so call 911.

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