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Does Medicare Cover the Shingles Vaccine? Will I Have to Pay For the Shot?

The CDC recommends people 50 years and older get the shingles vaccine. The shot is widely available and the cost may be covered if you have Medicare Advantage or Medicare Part D. Depending on your plan, you may have to cover a deductible, co-pay, or pay for the shot out of pocket and get reimbursement.

patient receiving a band aid after getting shingles shot

Shingles can cause serious complications, like painful long-term nerve damage. To stay safe from such complications, you may want to consider the new shingles vaccine (Shingrix). An older vaccine once widely administered in the U.S. (Zostavax) was less effective and is no longer on the market.

What is Shingles?

Shingles is caused by varicella zoster virus, which also causes chickenpox. After a person has chickenpox the virus stays dormant in the body. A case of shingles occurs when the virus again becomes active, often years or even decades after chickenpox.

Shingles causes painful rashes that normally appear as bands on one side of the body. Fever, headache, fatigue, and light sensitivity are potential side effects. The blisters of shingles typically form scabs in about a week and the rash clears completely in most people in about 2 to 4 weeks.

However, some people experience serious side effects from shingles. Reducing the risk of these complications by preventing a shingles outbreak is one reason why people get a shingles vaccine. Risk of complications increases with age, so it is important to see a doctor if you think you have shingles.

Possible complications of shingles include:

  • Postherpetic neuralgia (PHN) where nerve damage causes pain to continue after the shingles blisters are gone
  • Vision loss when blisters around the eye cause an eye infection and eye damage
  • Skin infections when shingles blisters are not properly treated
  • Neurological problems from nerve damage that may result in brain inflammation (encephalitis), facial paralysis, or issues with balance or hearing

The shingles vaccine can prevent these serious side effects. Many insurance plans cover shingles vaccinations, including some Medicare plans.

What Parts of Medicare Do Not Cover the Shingles Vaccine?

Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) do not cover the shingles vaccine. When people first become eligible for Medicare, they sign up for Parts A and B. But this won’t give you coverage for the shingles shot.

What Parts of Medicare Cover the Shingles Vaccine?

According to Medicare.gov, a Medicare Part D prescription drug plan should cover all preventive vaccines, including the shingles shot. Medicare Advantage plans are typically a bundle of Medicare Part A, Part B, and Part D. As long as your Advantage plan contains Part D, you should have coverage for the shingles shot. Some people call this plan Medicare Advantage with drug coverage.

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 Medicare’s Find a Medicare Plan tool. This tool allows you to compare Medicare Advantage and Part D plans.

What Are My Options for the Shingles Shot and How Does it Work?

As of November, 2020, there is only one shingles vaccine available in the United States. This goes by the trade name Shingrix.

Shingrix was approved by the FDA in October 2017. It is more than 90 percent effective at preventing shingles and postherpetic neuralgia (PHN) after two doses of the vaccine.

An earlier vaccine, Zostavax, is no longer in use in the United States as of November 18, 2020. Zostavax first got FDA approval in 2006. It was about 51 percent effective at preventing shingles and 67 percent effective at preventing PHN.

The CDC recommends getting Shingrix if you:

  • Had shingles
  • Aren’t sure of your chickenpox history
  • Received the Zostavax shot

Some people should not get Shingrix. They include anyone who is:

  • Pregnant or breastfeeding
  • Allergic to Shingrix or any of its parts
  • Not tested as immune to varicella zoster virus (the chickenpox vaccine may be recommended instead)
  • Currently living with shingles

The dosing schedule for Shingrix is two shots 2 to 6 months apart.

Shingrix is a recombinant vaccine. That means it uses a non-living part of the shingles virus (varicella zoster) to teach the immune system to fight an infection. Shingrix uses glycoprotein E, a protein found in the virus, in a suspension made of plant extract and bacteria extract. The Shingrix vaccine cannot cause a shingles outbreak.

How Much Does the Shingles Vaccine Cost and Will I Have to Pay?

Medicare Advantage HMO (Health Maintenance Organization) covers the shingles shot for the plans Intermountain Healthcare Nevada administers. It’s another good reason to choose a Medicare Advantage HMO plan. Depending on the plan, those with Medicare may have to pay upfront and receive reimbursement or pay a non-reimbursable copay. If you have not yet satisfied your Medicare deductible, you may have to pay the entire amount out-of-pocket.

The cost for the Shingrix vaccine ranges from $0 to $164.

What Questions Should You Ask Your Provider?

Ask your doctor any questions you have about the shingles vaccine. Here are some common queries people have:

  • Am I at risk for shingles?
  • Am I at risk for shingles complications?
  • Is the shingles vaccine safe?
  • Will the shingles vaccine interact with any of my medications?
  • What are the side effects of the vaccine?
  • Where can I get the vaccine?
  • How do I schedule my second dose?
  • Do you recommend I get the Shingrix vaccine?

Feel free to discuss any concerns you have about Shingrix with your doctor, before and after you get the vaccine.

Why Choose Intermountain Healthcare?

At Intermountain Healthcare, we are dedicated to providing high-quality healthcare in the heart of our community. With a large network of specialized services, including our myGeneration Clinics, we provide the healthcare you need for optimal wellness. To learn more about us and how you can get the shingles shot, contact us today.

 

*This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician or qualified healthcare professional. For more information about coverage, please check with your health plan.

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