Does Medicare Cover Shingles
Shingles is a viral disease that affects around 1 million people each year in the U.S. Although it can affect people at any stage of life, its most common in people over 50. Since shingles can be more painful the older you get, many Medicare recipients want to know if theyre covered for the shingles vaccine, which can reduce the risk of shingles by 90%.
The two vaccines currently available in the U.S. are Zostavax and Shingrix, although Shingrix is more effective and is the CDCs preferred vaccine. It comes in two doses taken 2 to 6 months apart, and most recipients have only mild side effects.
In this article, well look at ways to make sure youre protected from shingles and help you find out how much of the vaccines cost is covered by Medicare.
Where Can I Get Vaccines I Need
You can get most vaccines at a pharmacy, doctors office, clinic or community health center. Talk with your doctor about what vaccines you may need. Your doctor or Part D plan provider can also help you understand whether your cost will be affected by where you go to get the vaccines that your doctor recommends.
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Will Medicare Pay For Shingrix
You are going to want to make sure you have the correct Medicare plan .
BGA Insurance Group can help ensure that you are not surprised by charges you were not expecting. If you believe you need to get certain vaccines or prescription medications, you should contact us immediately to help you select a plan that makes the most sense for you.
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Medicare Shingles Vaccine Cost
The full cost of the shingles vaccine from Shingrix is $324, spread out across two shingles shots costing $162 each. If you have a prescription drug plan with Medicare, the approximate cost could be less than $50 per shot, a more than 60% discount from the full price!
While the premium of the prescription drug plan may be higher than that of a Medicare Advantage plan, the prescription drug plan will likely save you money on the vaccine in the long run.
What To Know About Medicare And Shingles Vaccine Coverage
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Vaccinations are an important part of both public and individual health. The Centers for Disease Control and Prevention recommends various types of vaccines for people throughout their lifetimes, including the tetanus shot and shingles vaccine.
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While Original Medicare does not cover the shingles vaccine, Medicare Part D, Medicares prescription drug coverage, covers all commercially available shots, including the shingles shot.
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Medicare Advantage plans may have different coverage options for vaccines. Individuals enrolled in a Medicare Advantage plan should confirm vaccination coverage with their insurance company.
Vaccinations are a vital component of keeping both individuals and communities safe and healthy. Medicare covers some vaccines. These include the flu shot, hepatitis B shot, pneumococcal shots, and COVID-19 vaccines.
There are a variety of vaccines the Centers for Disease Control and Prevention encourage children and adults to receive throughout their lifetime to prevent disease. One of these vaccinations is the shingles shot.
The CDC recommends the shingles vaccine for healthy adults over the age of 50. While Original Medicare does not cover the shingles vaccine, Medicare Part D does cover the shingles vaccine. This article will explain everything Medicare beneficiaries need to know about Medicare and vaccine coverage, specifically in regards to the shingles vaccination.
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What Steps Can You Take To Make Sure You Are Covered If You Have Medicare Advantage With Drug Coverage Or Medicare Part D
If you already have Medicare Advantage, or Medicare Part D, contact your provider to check your coverage. Medicare Advantage plans are offered by private companies that Medicare approves.
If you are not yet on Medicare and want to find a plan that covers the shingles shot, you can use Medicares Find a Medicare Plan tool. This tool allows you to compare Medicare Advantage and Part D plans.
Why Do You Need The Shingles Vaccine
In a word: pain. Shingles commonly appears as a rash, usually across one side of your chest, abdomen or face. What starts as itching or tingling becomes an extremely painful band of blisters. These usually scab over in seven to 10 days and clear up in two to four weeks.4
Shingles is most common among people over the age of 50, so the Centers for Disease Controls recommends the vaccine for anyone over that age.
People with a weak immune system are at even higher risk. Your immunity may be weakened if you:5
- Are under extreme stress.
Shingles must be active, meaning in the blister phase, to be contagious. You cannot transmit the virus before the blisters appear, nor once they crust over.6 Even if the virus is active, the risk of spreading VZV is low if you keep the shingles rash covered.7
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What Shingles Vaccine Costs Should I Be Aware Of
Original Medicare Part A and Part B do not currently offer coverage for the shingles vaccine. Generally, this vaccine, and other commercially available immunizations, can be covered under Medicare Part C or Medicare Part D .
Usually, even if you are covered for important vaccines under Medicare Advantage or Medicare Part D, you will still be required to pay a copay in order to receive them. However, because Medicare Advantage plans and Medicare Part D plans are offered by private insurance companies, the exact costs of deductibles, copays, and premiums can vary.
Who Should Not Get The Shingles Vaccine
The vaccine may not be appropriate for people who have a weakened immune system due to certain conditions. These people include those with an organ transplant and those who are undergoing chemotherapy to treat cancer.
Doctors also recommend that people with an allergy to any component of the vaccine do not have the shingles vaccination.
Anyone with severe allergies must tell a doctor about them when discussing their shingles risk. People who are pregnant or breastfeeding or currently have shingles symptoms should not get the shot.
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How Much You Might Still Have To Pay
According to Consumer Reports, the shingles vaccine costs around $217 at full price, but the average cost for people with Medicare Part D is $50 for each shot. Some plans have a higher copay, while some plans charge less or even $0.
Before you go to the pharmacy to get vaccinated, call them to find out the current price of the vaccine, and call your insurer to confirm that they will cover it. To get the lowest copay, make sure the pharmacy is in your insurers network.
You can also ask your doctor about getting vaccinated at the doctors office, but make sure to ask them how much they charge for the vaccination and if they can bill your insurer.
Some doctors may charge more for the vaccine than your insurer will cover, and some may expect you to pay out of pocket and be reimbursed later. If your doctor cant bill your insurer, then ask them to write you a prescription for an in-network pharmacy instead.
Vaccines Covered By Medicare Part D
Medicare Part D covers all commercially available vaccines needed to prevent illness. You can get Part D coverage through a stand-alone Medicare prescription drug plan or a Medicare Advantage plan that includes drug coverage.
Vaccines covered by Part D include the following:
- Shingles vaccine: One-time vaccine given in two shots over two to six months
- Tdap vaccine : One shot if youve never been vaccinated, and a booster every ten years
- Other vaccines covered: Vaccines that are reasonable and necessary to prevent illness and are not covered by Part B
Part D may also cover vaccines you may need if you are traveling internationally. Talk with your doctor about your travel plans and ask what vaccines are recommended.
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You Can Get A Shingles Vaccine Two Ways:
At the pharmacy. Youll still need a doctors prescription, but once thats been transmitted, you can get the shot at a retail pharmacy.
Most major chains and some independent pharmacies can administer the vaccine. Just make sure to use a store in your drug plans network so that it can bill your plan directly and youll owe just the copayment.
At the doctors office. If youre vaccinated in a doctors office, check whether it can bill your drug plan directly or works with a pharmacy that can do so. If so, it will work as mentioned above, with you owing a copayment. If not, you may need to pay the full cost up front and then file a claim for reimbursement from your plan.
Remember that the doctors fee for administering the vaccine may exceed your plans allowable charge, in which you case youre on the hook for the difference. It pays to check beforehand.
Editor’s note: This article was originally published on Jan. 1, 2014. It has been updated with the latest information regarding Medicare coverage in 2020.
Does Medicare Cover Shingles Vaccine
Learn if Medicare covers the cost of your shingles vaccination
The shingles vaccine is given in one dose and has a 51% effective rate at reducing the risk of developing shingles. It is suggested that adults 60 and over get the one dose shot to help prevent getting shingles, even if you have not had chicken pox*. The shingles vaccine can be expensive, so the big question is, does Medicare cover it?
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What Should I Do If I Have Shingles
If you think you may have shingles, see a doctor as soon as possible and get a professional diagnosis. While some cases are mild and may clear up on their own without treatment, other cases can cause severe pain and require medication to manage.
Its also important to take steps to avoid spreading the virus. The Centers for Disease Control recommends keeping the rash covered and washing your hands often. Avoid touching the rash as much as possible and avoid contact with people who may be at risk, including:
- Premature infants
- Pregnant women who have not had chickenpox or been vaccinated for it
- People with HIV or weakened immune systems due to cancer treatment, organ transplant, or immunosuppressive drugs
Your doctor may recommend antiviral drugs, or simply treating the rash with over-the-counter medication such as calamine lotion to soothe the pain of the blisters. Treatment can reduce the pain and duration of the symptoms, but doesnt cure the disease altogether.
For many seniors, the most painful part of shingles isnt the rash, but post-herpetic neuralgia, which can last a year or more in some cases. Although not everyone who gets shingles will experience post-herpetic neuralgia, it can have a big impact on those that do. Some people develop chronic pain that lasts for years and affects their quality of life.
Why Is The Shingles Vaccine Not Covered By Medicare
Medicare Part B covers COVID-19, influenza and pneumococcal vaccines. It may also cover the Hepatitis B vaccine if your doctor thinks you are at a higher risk of contracting the disease. However, original Medicare doesn’t cover the shingles vaccine, and it’s unclear exactly why.
However, you may be covered for the shingles vaccine if you purchase Medicare Part D insurance through an approved private insurer or have a Medicare Advantage Plan that includes Part D coverage. However, you’ll be liable for your Part D deductible if you haven’t already paid it in the year you have your shingles vaccine. Part D deductibles vary widely between providers, but there is a mandatory maximum cap of $445 as of 2021.
The only commercially available shingles vaccines are Shingrix and Zostavax. The average cost of a Shingrix shot is around $190, so beneficiaries who haven’t yet paid their deductible are likely to end up paying for the entire cost of their shingles vaccine.
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Medicare Part D Coverage
Original Medicare doesnt cover most prescription drugs, but you do have the option of purchasing a Part D plan. These plans are sold by private insurers and offer coverage for a range of prescription drugs.
While there is some variation in Part D plans since they are provided by different private companies, they typically must include coverage for Shingrix.
Does Medicare Cover Shingles Vaccines In 2022
Shingles is a viral infection caused by the varicella-zoster virus . 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 recommends that adults older than 50 get the shingles vaccine. Shingles can cause long-term nerve pain 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, wasdiscontinued in 2020.
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Does Medicare Cover The Shingles Vaccine In Florida
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Dear Connie,
I had a friend get shingles, and it was awful.
Now that Ive seen it first-hand, I definitely want to get the vaccine. But Ive heard that Medicare does not cover it. Is that true? Or does Medicare cover the shingles vaccine in Florida?
Scared of shingles,Gail from Belle Isle, Florida
Find the right Medicare plan for you
Dear Gail,
Were so sorry to hear that your friend had shingles. Sometimes it takes seeing something first-hand or helping someone through a health scare to realize we need to take action.
The Centers for Disease Control and Prevention recommends that adults 50 years and older get the shingles vaccine.
Shingles is a viral infection caused by the same virus strain that manifests as chicken pox. This means that if youve ever had chickenpox, you are at a higher risk of getting shingles as you age. In fact, one in every three people is at risk for shingles or herpes zoster. And there are serious complications.
Between 10% to 18% of people who get shingles will experience postherpetic neuralgia , which is severe pain in the areas where the shingles rash occurs.
Agent tip:
Starting January 1, 2023, you will not have any out-of-pocket Medicare costs for the shingles vaccine.
How Well Does Zostavax Work
Zostavax®, the shingles vaccine, reduced the risk of shingles by 51% and the risk of post-herpetic neuralgia by 67% based on a large study of more than 38,000 adults aged 60 years or older. Protection from shingles vaccine lasts about 5 years.
While the vaccine was most effective in people 60 through 69 years old, it also provides some protection for people 70 years old and older.
Adults vaccinated before age 60 years might not be protected later in life when the risk for shingles and its complications are greatest.
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Medicare Does Not Cover Shingrix But Soon It Will
Haley Hernandez, Health Reporter
The CDC recommends adults 50 years and older get two doses of the shingles vaccine called Shingrix to prevent complications from the disease.
Its more than 90% effective in preventing illness, according to the CDC. But for many people on Medicare, its unaffordable.
Despite covering preventative care, Medicare does not cover the shingles vaccine and at times charges up to $200 for the shot.
In January, that will change. The Inflation Reduction Act aims to reduce the cost of some drugs and close this barrier to good healthcare.
As of January 2023, all vaccinations that are covered under Medicare part D that are approved and recommended by the Centers for Medicare and Medicaid, and also by the CDC, will be covered without a co-pay. So, no cost sharing is going to be associated with , said Alejandra Rischan, lead benefits counselor for the Houston-Galveston area Counsel.
Rischan said the most common question she gets is why the shingles vaccine isnt covered by Medicare, but the Inflation Reduction Act is set to change that.
All these changes are kind of slowly trickling out with the information, and there are a lot of changes that are going to be coming in the next five years for folks who are on Medicare to save a little bit more money, so were really excited to see the rollout of this program, Rischan said.
Is The Shingles Shot Covered By Medicare
Original Medicare does not pay for the shingles vaccine. However, if youre enrolled in a Medicare prescription drug plan or have a Medicare Advantage plan that includes drug coverage, your shot may be covered. For vaccines covered under Part D , it is not recommended to get the shot through your providers office, as you may have issues with Part D billing.*
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