Does Medicare Cover Shingles Vaccine?

Shingles is a viral infection that causes a painful rash. It commonly occurs in elderly people.

It is caused by the varicella-zoster virus, which is the same virus that causes chickenpox. After having chickenpox, the virus may stay inactive in your body. If activates again, it causes shingles. Thankfully there are now vaccines available for shingles.

So a common question many people have is, “Does Medicare cover Shingles Vaccine?” In this article, we answer that question in clear, plain English. You will also find the average costs of shingles shots and other helpful info.

Does Medicare Cover Shingles Vaccine?

The short answer is no. In most cases, Medicare will not cover the cost of the shingles shots. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your shingles shots.

Original Medicare

Original Medicare (Medicare Part A and Part B) does not provide coverage for the shingles vaccine. So that means you will have to pay 100 percent of your shingles shots.

Part C

However, some Medicare Advantage plans (Medicare Part C) provide coverage for shingles shots. Medicare Advantage plans cover everything Original Medicare covers as well as some additional benefits. However, coverage and out-of-pocket costs will vary depending on the specifics of your plan.

Medicare Part C plans that provide Medicare Part D benefits do cover shingles shots.

Part D

Stand-alone Medicare Part D plans also provide coverage for shingles shots. However, coverage and out-of-pocket costs will vary depending on what Part D plan you have.

For you to find out if your Medicare Part C plan or Part D plan covers shingles shots, you have to follow these steps:

Contact your healthcare provider and ask them if they can bill your Medicare Part D directly
If your healthcare provider cannot directly bill your Medicare Part D plan, you can request that they coordinate with an in-network pharmacy.
Pharmacies may be able to provide you shingles shots and directly bill them to your Medicare Part D plan
If you are unable to have both your healthcare provider and pharmacy directly bill your Medicare Part D plan, you can pay for the full costs of your shingles shots later and send a vaccine bill for your Medicare Part D plan to reimburse it.

How Much Do Shingles Vaccines Cost?

On average, shingles shots cost between $200 and $250. The overall costs of your shingles vaccination may include the shot administration fee, the cost of the single shot of the vaccine, and even the consultation from your healthcare provider.

What Are The Two FDA-Approved Shingles Vaccines?

Currently, there are two brands of shingles shots that are approved by the Food and Drug Administration or FDA in short. Those are the Zostavax and the Shingrix vaccines. Shingrix vaccines contain inactivated viruses in their vaccines. This is more suitable for people who have more vulnerable immune systems. Zostavax is a live vaccine, so it contains the attenuated virus.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.