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If you’ve heard of shingles, you know it shows up as a painful, blistery rash. This intensely unpleasant condition is caused by the varicella-zoster virus (VZV)—the same virus responsible for chickenpox. If you had chickenpox when you were young, the virus remains “asleep” in your body for many years. As you get older, or if your immune system becomes compromised, VZV is more likely to reactivate and cause shingles.
Fortunately, you can get vaccinated against shingles and reduce your risk of developing this illness. But many people 65 or older wonder: “Does Medicare cover the shingles vaccine?” Here’s what you need to know about insurance coverage for this important immunization.
Understanding the shingles vaccine
Getting vaccinated is the best way to protect yourself against the pain and hassle of shingles. The Centers for Disease Control and Prevention (CDC) recommends Shingrix (recombinant zoster vaccine, or RZV). Approved by the U.S. Food and Drug Administration (FDA) in 2017, Shingrix was found to be more than 90% effective at preventing shingles and postherpetic neuralgia (PHN) in healthy adults age 50 and older.1 PHN is a condition that emerges in the aftermath of shingles, when severe pain lasts for months or even years after the rash clears up. It affects about 10% to 18% of people who have shingles.2
In terms of effectiveness, Shingrix is a major upgrade from the older Zostavax vaccine, which is no longer available in the U.S. Even if you were previously vaccinated with Zostavax, you should still get the Shingrix shot. (Note: If you received a shingles vaccination before 2020, you received Zostavax).
Who should get the shingles vaccine?
CDC advises that healthy adults age 50 and older receive the shingles vaccine. Shingrix is administered in two doses, typically given two to six months apart. Vaccination is also recommended for some adults age 19 years and older who have compromised immune systems.
Does original Medicare cover the shingles vaccine?
Original Medicare (Part A and Part B) does not cover the shingles vaccine. Part A generally covers hospital-related costs, while Part B covers outpatient care, such as doctor visits and preventive services. Although Part B pays for preventive vaccines like those for flu, pneumonia, hepatitis B, and COVID-19, it does not include coverage for Shingrix. That means if you only have original Medicare, you may have to pay some or all of the shingles shot cost out of pocket.
However, if you have a Medicare Part D (prescription drug plan) as standalone coverage or as part of a Medicare Advantage plan, you’re in luck. Thanks to the Inflation Reduction Act of 2022, Medicare Part D and Medicaid now cover Shingrix as of January 2023.
How much does Shingrix cost with Medicare Part D?
Part D plans, whether standalone or part of a Medicare Advantage plan, must include most commercially available vaccines on their list of covered drugs (formulary). This applies to all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), such as the vaccines for shingles, RSV, whooping cough, and more. ACIP provides guidance and recommendations on the safe and effective use of vaccines in the U.S.
Your Part D plan won’t charge you a copayment or apply a deductible for any vaccines ACIP recommends. You can avoid billing issues by asking up front if the provider administering the vaccine, such as your pharmacy, can bill your Part D plan directly.
How much does Shingrix cost without Medicare?
The Shingrix vaccine can be expensive. Without insurance coverage, you could pay up to $200 per dose, or $400 for the full two-dose vaccination.
But even if you don’t have Medicare or Medicaid, you can probably still receive a free shingles vaccine. The Affordable Care Act (ACA) mandates that all Health Insurance Marketplace plans and most private health insurance plans cover all vaccines recommended by ACIP (including Shingrix) with no cost-sharing (e.g., deductibles, copayments)—as long as they are administered in-network. In addition, the vaccine is free to anyone who receives benefits through the U.S. Department of Veterans Affairs (VA). Check with your insurance plan provider to find out if you can get the shingles shot with no out-of-pocket costs.
If you don’t have shingles vaccine coverage through Medicare or another insurance plan, contact the manufacturer of Shingrix. They offer an assistance program that helps eligible people afford this and other vaccines.
Is the shingles vaccine worth it?
Roughly 1 in 3 Americans will deal with shingles at least once in their lifetime,1 which means your chances of developing this condition are fairly high. As you age, your risk increases even more. This illness is not only painful and debilitating; it can lead to long-term health issues like PHN, vision loss (if the rash is on your face), pneumonia, and hearing problems. The shingles vaccine is a safe, simple, and highly effective way to avoid the misery of shingles, and side effects tend to be mild and short-lived.
“The Shingrix vaccine lowers your risk of developing shingles in the first place,” said Kathleen Cameron, a healthy aging expert and former Senior Director of NCOA’s Center for Healthy Aging. “But if you do develop a case, it reduces the chance of complications that can greatly impact your quality of life for a long time. Look at it like a smart investment in your long-term health.”
How can I get a free shingles vaccine?
You can get Shingrix at most doctor's offices and pharmacies like CVS and Walgreens (you may need to make an appointment). Some communities also offer health clinics where preventive vaccines are available. You don’t need a prescription to receive the shingles shot, and if you have Medicare, Medicaid, VA benefits, or nearly any type of private insurance, you should pay nothing out of your own pocket.
Find a shingles vaccination site near you at Vaccines.gov.
Learn about other vaccines for older adults that are fully covered by Medicare and Medicaid.
Sources
1. Centers for Disease Control and Prevention (CDC). Shingles Vaccination. Found on the internet at https://www.cdc.gov/shingles/vaccines/index.html
2. Centers for Disease Control and Prevention (CDC). Shingles Symptoms and Complications. Found on the internet at https://www.cdc.gov/shingles/signs-symptoms/index.html
