Does Medicare Cover the Shingles Vaccine?
Original Medicare does not cover Shingrix — the shingles shot. But most Medicare Part D prescription drug plans and Medicare Advantage plans that include prescription drug coverage will cover the shingles vaccine.
Does Medicare Cover Shingrix — the Shingles Shot?
While Original Medicare — Medicare Part A and Part B — does not cover the cost of the shingles vaccine, or Shingrix (recombinant zoster vaccine), you can purchase private plans — Medicare Advantage or Medicare Part D plans — that do cover the cost.
It is important to note that even if your Medicare Advantage or Medicare Part D plan covers the shingles shot, you may have a copayment or other out-of-pocket costs to pay. Check with your plan for particular details.
Medicare Part D prescription drug plans cover all commercially available vaccinations, except for those already covered under Original Medicare. But these plans will pay only if the vaccinations are considered “reasonable and necessary to prevent illness.”
- Shingles vaccine
- MMR vaccine (for measles, mumps and rubella)
- Tdap vaccine (adult booster shot for tetanus, diphtheria and pertussis — also called whooping cough)
- Other vaccines deemed reasonable and necessary to prevent illness
Medicare Advantage plans may include a Part D component that covers these shots.
Medicare Part B medical insurance, included in Original Medicare, pays for only a few types of vaccines.
- COVID-19 vaccine
- Flu vaccine
- Pneumococcal (pneumonia) vaccine
- Hepatitis B vaccine
- Vaccines related to treatment of an injury or exposure to a disease or condition (such as tetanus and rabies)
How Much Does the Shingles Shot Cost?
There is currently only one shingles vaccine available in the United States, sold under the brand name Shingrix. An older shingles vaccine called Zostavax (zoster vaccine live) was taken off the market in November 2020.
Shingrix is delivered in two shots. Without insurance, each shot retails for around $202 for a total of $404, according to GoodRX in 2021. Discounts can lower that cost by nearly $50 per shot.
Medicare Part D and Medicare Advantage plans may cover most of the cost of the Shingrix vaccine, but you could have out-of-pocket costs for both the shot and your doctor visits.
Before getting the vaccine, check with your plan’s administrator to make sure your policy covers the shingles shot.
How Does Work?
You receive two shots of the Shingrix shingles vaccine, and the shots are given two to six months apart. Studies show that the vaccine is safe and effective, creating a strong immune defense against shingles.
According to the U.S. Centers for Disease Control and Prevention, Shingrix has proven highly effective against the two biggest complications associated with the herpes zoster virus — shingles and postherpetic neuralgia (PHN). PHN is a condition that affects your nerve fibers and skin, causing a burning pain that continues long after the shingles rash disappears.
|50 to 69|
|70 and older|
Common side effects of the shot include a sore arm and redness and swelling around the injection site. Some people have reported a strong immune response — feeling fatigue, muscle pain, headaches, shivering, fever and stomach pain or nausea — that may last two to three days.
The immune reaction may come with the first or second dose, or with both doses of Shingrix.
If you are a healthy adult who is age 50 or older, the CDC recommends that you get both shots of the Shingrix vaccine, even if you have already had shingles, can’t remember if you had chickenpox or if you have already received the old Zostavax vaccine.
Who Should Not Get the Shingles Vaccine
Certain people should not receive the vaccine or should wait before getting the Shingrix shingles vaccine.
- People who have had a severe allergic reaction to any component of the vaccine or to a previous Shingrix vaccination
- People who have tested negative for immunity to the varicella zoster virus (if this is the case, get the chickenpox vaccine for protection from both chickenpox and shingles)
If you currently have shingles, you should wait until you recover before getting the shot. Even after you have had shingles, the painful condition can return.
Pregnant and breastfeeding women should also wait before getting the shingles vaccine.
If you have a moderate or severe illness that starts suddenly — something doctors call an acute illness — you should usually wait until you fully recover before getting the shingles shot.
8 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2020, December). Medicare Part D Vaccines. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Vaccines-Part-D-Factsheet-ICN908764.pdf
- U.S. Centers for Disease Control and Prevention. (2020, October 5). What Everyone Should Know About Zostavax. Retrieved from https://www.cdc.gov/vaccines/vpd/shingles/public/zostavax/index.html
- AARP. (2020). Does Medicare Cover the Shingles Vaccine? Retrieved from https://www.aarp.org/health/medicare-qa-tool/does-medicare-cover-shingles-shot/
- U.S. National Library of Medicine. (2018, December 1). Shingles. Retrieved from https://medlineplus.gov/ency/article/000858.htm
- U.S. Centers for Disease Control and Prevention. (2018, January 25). Shingles Vaccination. Retrieved from https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html
- U.S. Centers for Disease Control and Prevention. (2017, March 31). How to Pay for Vaccines. Retrieved from https://www.cdc.gov/vaccines/adults/pay-for-vaccines.html
- GoodRx. (n.d.). Shingrix. Retrieved from https://www.goodrx.com/shingrix
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Shingles Shots. Retrieved from https://www.medicare.gov/coverage/shingles-shots