Does Medicare Cover Shingles Vaccine?

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Does Medicare Cover Shingles Vaccine?

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Does Medicare cover the shingles vaccine? Does Medicare cover Shingrix or Zostavax, the two vaccines used for shingles? How much does the shingles vaccine cost? We’ll answer those questions and more with this overview of the Medicare shingles vaccine.

Is the shingles vaccine covered by medicare Part D?

Original Medicare will not cover the shingles vaccine.

However, the shingles vaccine can be covered if you have a Medicare Part D drug plan. With Original Medicare Part A (hospital insurance) plan and Medicare Part B (medical insurance), you will not receive any coverage for the shingles vaccine. 

does medicare pay for shingrix or Zostavax?

Is Shingrix covered by Medicare? What about Zostavax? Firstly, in order for Medicare to provide coverage for these two shingles vaccinations, you must be enrolled in a Medicare Part D drug plan.

Here are the 2 drug plan options that are available to you:

  1. Medicare Part D: If you are on Original Medicare or have a Medicare Supplement, you can enroll in a stand-alone Part D drug plan.
  2. Medicare Part C: Your other option is to enroll in Medicare Part C, also known as Medicare Advantage. Your Medicare Advantage plan needs to have Part D drug coverage (referred to as an MAPD plan).

How much does the shingles vaccine cost?

The cost of the shingles vaccine can be expensive. For instance, it can run up to around $300 per dose. The good news is that your Part D drug plan can drop the price of the shingles vaccine. Let’s look at the retail costs and compare them to Part D costs.

shingles vaccine cost

Shingrix

Retail vs Part D
$ 140
00 Per shot
  • 2 shots required
  • RETAIL PRICE: $280 Total Average for 2 Shingrix shots
  • If Part D covers 50% of the vaccine cost, you're left paying:
2 shots

Zostavax

Retail vs Part D
$ 220
00 Avg cost
  • 1 shot required
  • RETAIL PRICE: $220 Total Average for 1 Zostavax shot
  • If Part D covers 50% of the vaccine cost, you're left paying:
1 Shot

how much is the shingles vaccine without insurance?

IMPORTANT: When a drug is not covered by Original Medicare, it won’t be covered when your physician administers it to you — except if they can bill your Part D drug plan directly.

You will need to find Shingrix or Zostavax on your Part D drug plan formulary. After that, make sure to review your Part D formulary and see which drug tier these vaccines falls under. The majority of Part D drug plans will provide 50% of vaccine costs.

Shingrix will cost you $280 on average for the 2 shots required. Zostavax is a little less expensive and retails for around $220 for the 1 required shot.

How to get the new shingles vaccine covered by medicare?

Once you sign up for a Part D drug plan that covers the shingles shot vaccine, the next step is buying the vaccine.

Here is a quick guide that you can refer to make it easy. In order to make sure that the shingles vaccine is covered with a Part D drug plan or MAPD plan follow these 3 steps: 

  1. Contact your physician, doctor, or provider and ask them  if they are able to bill your Part D drug plan directly.
  2. If your provider is unable to bill your Part D plan directly, ask them to coordinate with a pharmacy that is “in-network”. It’s possible that the in-network pharmacy may be able to offer you the shingles vaccine and directly bill your drug plan.
  3. File your shingles vaccine bill for reimbursement with the Part D drug plan if you’re unable to accomplish the above options.

When you file for reimbursement (3rd option), you will be required to pay full price for your vaccine shot when your receive it. The drug plan will most likely reimburse you. However, the costs covered are going to vary from plan to plan. The amount covered will also vary based on if the pharmacy was in your network or not.

Shingles Medicare Questions

Do you have any questions about the shingles vaccine? Are you wondering which Medicare Part D plans will provide the best coverage for the shingles vaccine? We’re here to help you. Just give us a call today.

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