{"id":630288,"date":"2024-11-04T16:27:26","date_gmt":"2024-11-04T21:27:26","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=630288"},"modified":"2026-01-13T12:57:28","modified_gmt":"2026-01-13T17:57:28","slug":"does-medicaid-cover-shingrix","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-medicaid-cover-shingrix\/","title":{"rendered":"Does Medicaid cover Shingrix?"},"content":{"rendered":"

Shingles<\/span><\/a> is a painful condition caused by the reactivation of the <\/span>varicella-zoster virus<\/span>, which is the virus that also causes chickenpox. The chances of getting shingles increase with age as the immune system gets weaker. Shingles can lead to severe complications, including long-lasting pain and, in rare cases, eye or hearing damage.<\/span><\/p>\n

Shingrix<\/span><\/a> is a very effective vaccine recommended for adults 50 and older and those with weakened immune systems. It contains inactivated varicella-zoster, which aids the body in producing more antibodies than necessary to fight the virus with a stronger immune system response. Since the <\/span>Centers for Disease Control and Prevention (CDC) recommends Shingrix<\/a><\/span> to prevent shingles, and it is the only shingles vaccine, you may wonder whether <\/span>Medicaid<\/span> covers it as a prescription drug benefit.\u00a0\u00a0\u00a0<\/span><\/p>\n

Does Medicaid cover Shingrix?\u00a0<\/span><\/h2>\n

Yes, but coverage varies by state.\u00a0<\/span><\/p>\n

Starting in 2023, the Inflation Reduction Act of 2022 made vaccines more accessible for Medicare and Medicaid recipients. If you have Medicaid and live in a state with expanded Medicaid coverage, it\u2019s likely that you will have low or no costs for <\/span>vaccines recommended by the Advisory Committee on Immunization Practices (ACIP)<\/span><\/a>, and Shingrix is one of them. However, that\u2019s only in <\/span>states that expanded Medicaid<\/span><\/a> under the Affordable Care Act.\u00a0<\/span><\/p>\n

If you live in one of the states that have not yet expanded Medicaid, you may or may not have coverage for Shingrix. If you do, there may be age restrictions, and you may have to pay a higher copay or coinsurance.\u00a0<\/span><\/p>\n

How much does Shingrix cost?\u00a0<\/span><\/h2>\n

Without insurance, Medicare, or Medicaid, <\/span>Shingrix costs over $500<\/span><\/a> for both doses. But the cost of Shingrix can vary depending on several factors, including where you live and which pharmacy you use.\u00a0<\/span><\/p>\n

As of the time of publication, the average retail price of Shingrix is $293 per dose. But most people don\u2019t pay this price if they have health insurance, including Medicaid.<\/span><\/p>\n

Costs of Shingrix with Medicaid\u00a0<\/span><\/h3>\n

If you live in one of the 41 states that expanded Medicaid and get your vaccine with an in-network provider, you\u2019re likely to pay less than $5 per dose of Shingrix, <\/span>according to GSK<\/span><\/a>, its manufacturer. Ultimately, however, <\/span>the cost of Shingrix with Medicaid will depend on your state’s specific plan details. You might still have some out-of-pocket expenses, such as:<\/span><\/p>\n