Medicare And The Shingles Vaccine: Are You Covered
The shingles vaccine is covered through Medicare Part D or Medicare Advantage as part of your prescription drug benefits. In 2022, your actual costs for the vaccine depend on the specifics of your plan.
Beginning Jan. 1, 2023, all vaccines will be free under Medicare Advantage or Part D including shingles. No matter your plan, you’ll pay no deductible, copay or other costs for a shingles vaccine.
In 2022, you could pay less than $50 per shingles shot with a Medicare Part D plan from Aetna or Wellcare. If you don’t have prescription drug coverage, the full price for two doses of the Shingrix vaccine is $324, and several cost-saving options can help you get Shingrix for less.
Find Cheap Medicare Plans in Your Area
Mild Side Effects Of Shingles Vaccine:
- Redness, soreness, swelling, or itching at the site of the injection .
It is safe to be around infants and young children, pregnant women, or people with weakened immune systems after you get the shingles vaccine. There is no documentation of a person getting chickenpox from someone who has received the shingles vaccine .
Some people who get the shingles vaccine will develop a chickenpox-like rash near the place where they were vaccinated. As a precaution, this rash should be covered until it disappears.
Like all vaccines, shingles vaccine is being closely monitored for unusual or severe problems by CDC and FDA.
Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would start a few minutes to a few hours after the vaccination. If you have a severe allergic reaction or other emergency that cant wait, call 9-1-1 or get the person to the nearest hospital. Otherwise, call your doctor.
Afterward, the reaction should be reported to the Vaccine Adverse Event Reporting System . Your doctor might file this report, or you can do it yourself through the VAERS website, or by calling 1-800-822-7967.
The shingles vaccine does not contain thimerosal .
This information was taken directly from the Shingles Vaccine Information Statement dated 10/06/2009.
For more information on possible side effects from vaccination, visit CDCs Possible Side Effects from Vaccines page.
Make A Plan To Get 2 Doses
- You can get Shingrix at your doctors office or pharmacy. Talk to your doctor or pharmacist about getting Shingrix.
- Plan to get your second dose of Shingrix 2 to 6 months after your first dose.
Five years later, I still take prescription medication for pain. My shingles rash quickly developed into open, oozing sores that in only a few days required me to be hospitalized. I could not eat, sleep, or perform even the most minor tasks. It was totally debilitating. The pain still limits my activity levels to this day.
A 63-year-old harpist who was unable to continue playing due to shingles
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How Cdc Monitors Vaccine Safety
CDC and FDA monitor the safety of vaccines after they are approved or authorized. If a problem is found with a vaccine, CDC and FDA will inform health officials, health care providers, and the public.
CDC uses 3 systems to monitor vaccine safety:
- The Vaccine Adverse Event Reporting System : an early warning system, co-managed by CDC and FDA, to monitor for potential vaccine safety problems. Anyone can report possible vaccine side effects to VAERS.
- The Vaccine Safety Datalink : a collaboration between CDC and 9 health care organizations that conducts vaccine safety monitoring and research.
- The Clinical Immunization Safety Assessment Project: a partnership between CDC and several medical research centers that provides expert consultation and conducts clinical research on vaccine-associated health risks.
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In Extreme Cases Shingles Can Also Result In Pneumonia Hearing Problems Blindness Encephalitis And Death
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How To Save Money On Vaccines
If youre uninsured or having trouble paying for your vaccines, talk to your CVS pharmacist.
GoodRx offers discounts on vaccines as well as medications. You can print or show the CVS pharmacist a GoodRx coupon. For the shingles vaccine Shingrix, for example, you can save as much as 22% off the average retail price. Another GoodRx coupon can help save as much as 36% off a Tdap vaccine.
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Does Medicare Cover The Shingles Vaccine
All Medicare prescription drug plans offer some level of coverage for the shingles vaccine. You will find this coverage under your Medicare Part D plan or a Medicare Advantage plan.
The amount you pay will vary based on your policy details and your deductible amount. For some enrollees, the shingles vaccine could be free, but others may pay full price if a deductible must be met before the cost-sharing benefits begin.
The shingles vaccine is not covered by Original Medicare . However, Medicare Part B may cover a doctor’s visit to get a prescription for the shingles vaccine.
Most Medigap plans, also called Medicare supplement plans, don’t cover the shingles vaccine because they don’t include prescription drug coverage.
Typical costs based on available plans in Charlotte, N.C. , Boston , and Los Angeles .
Find Cheap Medicare Plans in Your Area
Remember that coverage for the shingles vaccine is usually just one aspect of your prescription drug needs. And the best Medicare Part D plan for you is determined by its total performance, including how well its coverage matches your prescription needs.
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How Does Your Medicare Deductible Affect Your Vaccine Costs
The deductible amount of your Medicare plan affects how much you pay out of pocket before your insurer starts contributing to the cost of your prescription drugs. Depending on how many medications you take, the deductible could affect how much you spend on the vaccine.
Below, we’ll compare how much you’d pay for the shingles vaccine on two plans with different deductibles. In this situation, the person with the MedicareRx Walgreens plan pays less overall, even though they’re paying full price for the shingles vaccine.
Scenario: Shingrix is the only medication needed during the policy
|AARP MedicareRx Walgreens
|Cost of two doses of Shingrix vaccine
|$160 each, for a total of $320, because the deductible hasn’t been met
|$45 copay each, for a total of $90
|Total annual cost of premiums and shingles vaccine
In the example above, the AARP MedicareRx Walgreens prescription drug plan has a $455 deductible for Tier 3 drugs like the shingles vaccine. That means if you haven’t already met your deductible, you would pay full price for the vaccine, which would be $320 for two doses. The plan costs $38.60 per month for someone living in Charlotte, N.C. If the shingles vaccine is the only Tier 3, 4, or 5 drug needed during the policy year, your total annual spending would be $788.
Shingrix Coupons Copay Cards And Rebates
Shingrix offers may be in the form of a printable coupon, rebate, savings or copay card, trial offer, or free samples.Some offers may be printed right from a website, others require registration, completing a questionnaire,or obtaining a sample from the doctors office.
There are currently no Manufacturer Promotions that we know about for this drug.
Vaccine Effectiveness And Safety
The vaccine reduces your chance of getting the virus by more than 50%, depending on your age. Vaccine effectiveness is higher among seniors between 65 and 70 years old.
No vaccine is 100% effective. If you get vaccinated, you may still develop shingles. But the infection would likely be less severe and youd be better protected from complications.
The vaccine has been licenced by Health Canada, having met all requirements under the Food and Drugs Act.
How Can I Get A Shingles Vaccine
While most people get their shingles shots at a pharmacy, some receive it at their doctors office. At one time, some states required a prescription to get the shingles vaccine at a pharmacy, but those states have recently changed their rules. Now you dont need a prescription to get the shingles vaccine.
At a pharmacy. Pharmacists in all states can administer vaccines included on the CDC-recommended adult immunization schedule, including the shingles vaccine. Make sure your pharmacy is in your Part D plans network so it can bill your plan directly. Check with your pharmacy and insurance plan for details.
At a doctors office. Its a good idea to confirm your doctor can bill Medicare Part D before you plan to get the vaccine there. Otherwise, you may need to pay for the vaccine and submit a claim for reimbursement to your Part D plan. Ask the doctors office and your plan about the rules.
Keep in mind
If you have trouble affording Part D prescription drug coverage, you may qualify for the Extra Help program, a government program that helps people with limited income and assets pay premiums and out-of-pocket costs for Part D drug coverage. Starting in 2024, the Inflation Reduction Act also expands the level of income eligibility for the Extra Help program.
Update October 11, 2022
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How Much Does Shingrix Cost
The price you pay for Shingrix can vary. Your cost may depend on your treatment plan, your insurance coverage , and the pharmacy you use. It will also depend on how much you have to pay for visits with your doctor if you get Shingrix at a healthcare facility.
To find out how much youll pay for Shingrix, talk with your doctor, pharmacist, or insurance provider.
On these sites, you can find insurance information, details on drug assistance programs, and links to savings cards and other services.
While no coupon is offered for Shingrix, most insurance plans cover the vaccine for eligible adults. If you dont have insurance, a program called GSK for You may be available to help with the cost of Shingrix.
If you have questions about how to pay for your vaccine, talk with your doctor or pharmacist.
Below are answers to some common questions about Shingrix and cost.
What Parts Of Medicare Cover The Shingles Vaccine
- Medicare Part C. Medicare Advantage is a plan you can buy through a private insurance company. It may offer additional benefits not covered by original Medicare, including some preventive services. Many Medicare Advantage plans include prescription drug coverage, which would cover the shingles vaccine.
- Medicare Part D. This is the prescription drug coverage portion of Medicare and typically covers commercially available vaccines. Medicare requires Part D plans to cover the shingles shot, but the amount it covers can be very different from plan to plan.
Making Sure Youre covered
There are a few steps you can take to make sure your shingles vaccine is covered if you have Medicare Advantage with drug coverage or Medicare Part D:
- If your doctor cant bill your plan directly, ask your doctor to coordinate with an in-network pharmacy. The pharmacy might be able to give you the vaccine and bill your plan directly.
- File your vaccine bill for reimbursement with your plan if you cant do either of the options above.
If you have to file for reimbursement, youll have to pay the full price of the shot when you get it. Your plan should reimburse you, but the amount covered will vary based on your plan and if the pharmacy was in your network.
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What Happens When You Get The Vaccine
As mentioned above, there is one option for the shingles vaccine: Shingrix.
Shingrix, which contains no live virus, is a two-dose vaccine series given in the muscle of the upper arm. The second shot is given two to six months after the first. In clinical trials, it was effective in nearly 97% of adults in their 50s over 97% effective for people in their 60s and over 91% effective for those aged 70 and above. It remains at near 85% effectiveness in all four years following vaccination.18
Shingrix is recommended if youre age 50 or older and have no severe immune problems.19
Effectiveness does come with a cost: In studies, seven in 10 people experienced pain from the Shingrix vaccine, and nearly half have muscle pain or fatigue and some had headaches, shivering, fever and nausea.20 21The CDC suggests avoiding strenuous activities for two to three days after getting either Shingrix shot.
If have previously received Zostavax, you can consider getting Shingrix. The CDC says Shingrix was safe and immunogenic when given five years or later after Zostavax. The agency adds there is no data or theoretical concerns that Shingrix would be any less effective if given sooner. 21
Zostavax was discontinued in 2020 by Merck and is no longer available in the United States.
How Much Is A Shingles Shot Under Medicare Part D
The good news is that the cost of a shingles vaccine, which comes in two timed doses, is subject to change in 2023.
Starting in 2023, the Inflation Reduction Act will eliminate all out-of-pocket costs for vaccines that the CDCs Advisory Committee on Immunization Practices recommends for adults. That includes the shingles vaccine.
However, in 2022 you may be charged a copayment for the shingles vaccine. This varies from plan to plan. The average Part D copayment for vaccines was $47 in 2020, according to Avalere Health, a health care consulting firm.
If you havent yet met your plans annual Part D deductible, which can be up to $480 in 2022, you may have to pay more for the shot. Shingrix, a vaccine the Food and Drug Administration approved in 2017, runs around $212 per dose.
It replaced Zostavax in November 2020. But even if you received Zostavax before it was retired, the CDC recommends getting inoculated with Shingrix: two doses for adults 50 and older spaced two to six months apart.
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What Are The Possible Side Effects Of Shingrix
Studies show that Shingrix is safe. The vaccine helps your body create a strong defense against shingles. As a result, you are likely to have temporary side effects from getting the shots. The side effects might affect your ability to do normal daily activities for 2 to 3 days.
Most people got a sore arm with mild or moderate pain after getting Shingrix, and some also had redness and swelling where they got the shot. Some people felt tired, had muscle pain, a headache, shivering, fever, stomach pain, or nausea. Some people who got Shingrix experienced side effects that prevented them from doing regular activities. Symptoms went away on their own in about 2 to 3 days. Side effects were more common in younger people.
You might have a reaction to the first or second dose of Shingrix, or both doses. If you experience side effects, you may choose to take over-the-counter pain medicine such as ibuprofen or acetaminophen.
Guillain-Barré syndrome , a serious nervous system disorder, has been reported very rarely after Shingrix. There is also a very small increased risk of GBS after having shingles.
If you experience side effects from Shingrix, you should report them to the Vaccine Adverse Event Reporting System . Your doctor might file this report, or you can do it yourself through the VAERS websiteexternal icon, or by calling 1-800-822-7967.
If you have any questions about side effects from Shingrix, talk with your doctor.
Why Is The Shingles Vaccine Recommended
The Centers for Disease Control and Prevention recommends that healthy adults 50 years and older get two doses of Shingrix two to six months apart to prevent shingles and complications from the disease. The vaccine is typically administered to adults who are 50 years and older. There is no maximum age for getting Shingrix.
It is also given to those who have received a live zoster vaccine in the past.
The studies report that two doses of Shingrix will be more than 90 percent effective at preventing shingles and its complication called postherpetic neuralgia.
The vaccine protects you at least 85 percent of the time for the first four years after vaccination.
You should get Shingrix even if you have a history as follows:
- Already had shingles
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What Causes Shingles
The varicella zoster virus causes shingles. Its the same virus that causes chickenpox.
Shingles is a painful skin rash with blisters that can occur anywhere on the body but usually shows up in a strip on either side. In some cases, the rash occurs on one side of the face.
A shingles infection can be very serious. It can lead to complications such as loss of vision and debilitating nerve pain.
What The Cdc Says
The CDC recommends healthy adults 50 and older get the new Shingrix vaccine. The agency says even people have received Zostavax should get it. The CDC also recommends it for anyone who has had chickenpox or shingles in the past.
The agency warns that some people should not get Shingrix vaccinations. These include people who may be allergic to the vaccine or any of its components. People who test negative for the chickenpox virus should not get Shingrix. They should choose the chickenpox vaccine instead. People who currently have shingles should not get the vaccine. And the CDC recommends women who are pregnant or breastfeeding should wait to get it.
Shingrix side effects reported in clinical trials were minor. One in six people reported side effects that affected their regular activities. The CDC said the effects went away in two to three days. The most common side effect was a sore arm with mild to moderate pain. Other people reported tiredness, headache and some flu-like symptoms. Most side effects were in younger patients.
The CDC said patients could treat most side effects with over-the-counter drugs. The results came from a clinical trial of 15,000 patients given Shingrix on four continents.
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