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Shingles is a fairly common virus that affects over 3 million people a year in the US. Having known a few people who have had it, it can be agony to live with.
But what exactly is shingles? Having shingles means there is herpes zoster in your body. This is the same virus that causes chickenpox. In adults, it causes an extremely painful rash.
Thankfully there are vaccines for shingles. One of which is known as Shingrix.
So a common question many people who want to avoid shingles have is, “Does Medicare cover Shingrix?” In this article, we answer that question in clear, plain English. You will also find the average cost of the Shingrix vaccine and other helpful info.
Does Medicare Cover Shingrix?
The short answer is no. In most cases, Medicare will not cover the cost of the Shingrix vaccines. 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 Shingrix vaccines.
Original Medicare (Medicare Part A and Part B) does not provide coverage for Shingrix vaccines. So that means you will have to pay 100 percent of the cost.
However, some Medicare Advantage plans (Medicare Part C) provide coverage for Shingrix. 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 have Medicare Part D benefits usually provide coverage for Shingrix vaccines.
Stand-alone Medicare Part D plans also provide coverage for Shingrix. However, coverage and out-of-pocket costs will vary depending on the plan you have.
In order to know if your Medicare Part C plan or Part D plan covers Shingrix vaccines, here are the steps to follow:
- Contact your healthcare provider to find out if they can bill your Medicare Part D plan directly
- If your healthcare provider cannot bill your Medicare Part D plan directly, you can ask them to coordinate with an in-network pharmacy. The pharmacy might be able to provide you the vaccine and bill your Medicare Part D plan directly.
- If you are unable to do any of the options above, file your vaccine bill for reimbursement with your Medicare Part D plan. Meaning, you will pay the full price of the Shingrix vaccine but (hopefully) your Medicare Part D plan will reimburse you for it.
How Much Does Shingrix Vaccines Cost?
Shingles vaccine usually cost from $200 to $250. The costs of shingles vaccines may include the shot administration fee, the costs of a single dose of vaccine, and in some cases, a visit or consultation from your doctor.
How Do Shingles Vaccines Work?
Right now there are two brands of shingles vaccines approved by the Food and Drug Administration (FDA). One is a live zoster vaccine live, or Zostavax. The other is a recombinant zoster vaccine, or Shingrix.
Shingrix contains inactivated viruses in their vaccines, making it more tolerable for people with weaker immune systems. On the other hand, Zostavax contains attenuated viruses.
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.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover Promacta?