Does Medicare Cover Zostavax?

About one-third of the people of the U.S. who had chickenpox will get shingles.

The good news is that there are vaccines available for shingles so you can avoid this painful condition. The two vaccines for shingles are Shingrix and Zostavax.

So a common question many people have is, “Does Medicare cover Zostavax?” (get the answer for Shingrix here).

In this article, we answer that question in clear, plain English. You will also find the average costs of the Zostavax vaccine and other helpful info.

The short answer is no. In most cases, Medicare will not cover the cost of the Zostavax vaccine. 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 Zostavax vaccines.

Original Medicare

Original Medicare (Medicare Part A and Part B) does not provide coverage for the Zostavax vaccine. That is because Original Medicare does not cover shingles vaccines, no matter what brand we’re talking about. So that means you will have to pay 100 percent of your Zostavax vaccines if you rely on Original Medicare.

Medicare Advantage

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

Part D

Stand-alone Medicare Part D plans also provide coverage for Zostavax vaccines. Coverage and how much your plan will pay for depends on what Part D plan you have.

In order to find out if your Medicare Part C plan or Part D plan covers Zostavax vaccines, you can follow these steps:

Contact your healthcare provider and ask them if they can bill your Medicare Part D plan directly
If not, an alternative is for 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 neither of the two options above work for you, you can file your vaccine bill for reimbursement with your Medicare Part D plan. Meaning, you will pay the full price of the Zostavax vaccine, but your Medicare Part D plan will hopefully reimburse you for it.

How Much Does Zostavax Vaccines Cost?

On average, shingles vaccines cost from $200 to $250. The overall costs of shingles vaccines may include the following:

Shot administration fee
Costs of the single required dose of vaccine
Visits or consultation with the doctor

Differences Between Shingrix And Zostavax

These are the two main vaccines available right now for shingles. Here are some of the main differences between them:

The Zostavax vaccine is injected beneath the skin. On the other hand, Shingrix is injected into the muscle.

Zostavax is a one time vaccine where you get a 0.65 ml dose. Meanwhile, Shingrix requires two doses. You’ll get 0.5 ml dose each time. The shots are spread out between 2 to 6 months apart.

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.