How Medicare Covers the Shingles Vaccine
Medicare Part A and Part B won’t cover the shingles vaccines. However, If you have Medicare Part D, the optional prescription drug benefit, your shingles vaccine is required to provide coverage for the shingles vaccines.
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The Shingles vaccine, which protects against shingles and the complications from the disease (recommended for healthy adults 50 years and older by the CDC)
You can get a shingles vaccine two ways:
- At the pharmacy. Medicare requires all Part D plans to cover the shingles vaccine. However, since Part D plans have networks, You’ll still need a doctor’s prescription and you’ll want to be sure you get the vaccine at a pharmacy in the plan’s network.
- At a doctors office. If you are vaccinated in a doctor’s 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 for the shot out of your own pocket first and then file a claim for reimbursement from your plan.
It’s a good thing that Part D covers shingles vaccines because there are an estimated 1 million new cases of shingles each year in the United States. The risk of an outbreak increases with age, so people over 65 are more susceptible than younger adults.
How much will the shingles vaccine cost?
The amount you pay for the shingles vaccine will depend on how much your Medicare plan covers. Remember that if you only have original Medicare and no prescription drug coverage through Medicare, you may pay full price for the vaccine.
Medicare drug plans group their medications by tier. Where a drug falls on the tier can determine how expensive it is. Most Medicare drug plans cover at least 50 percent of a drug’s retail price.
According to GoodRx, the shingles vaccine has an average cash price of $196.31
If you receive your vaccine before you have met your Part D plan’s deductible, you will be responsible for 100% of the cost. However, if you get your vaccine after having met your deductible, you will simply pay a copay or coinsurance for the shot.
To find out exactly how much you will pay, review your plan’s formulary or contact your plan directly.
If you do not have a Part D drug plan
Cost-saving tips
- If you qualify for Medicaid, check with your state’s Medicaid office about coverage for the shingles vaccine, which may be free or offered at a low cost.
- Look for prescription assistance and coupons on websites that help with medication costs. Examples include GoodRX.com and NeedyMeds.org. These sites can also help you search for the best deal on where to get the vaccine.
- Contact the vaccine’s manufacturer directly to ask for potential rebates or discounts. GlaxoSmithKline manufactures the Shingrix vaccine. Merck manufactures Zostavax.
Do you have questions about which Medicare plans will cover the shingles vaccine? Or perhaps you need help finding a drug plan that includes other vaccines covered by Medicare Part D? Request a call back from one of our agents.
