Does Medicare Cover the Shingles Vaccine?

Original Medicare does not cover Shingrix — the shingles shot. Starting January 1, 2023, all Medicare Advantage or Part D plans will cover the shingles shot, with no deductible or cost-sharing. This is a new benefit. In 2022, there were potential out-of-pocket costs for a shingles vaccine.

Terry Turner, writer and researcher for RetireGuide
  • Written by
    Terry Turner

    Terry Turner

    Senior Financial Writer and Financial Wellness Facilitator

    Terry Turner has more than 35 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).

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    Lee Williams
    Lee Williams, senior editor for RetireGuide.com

    Lee Williams

    Senior Financial Editor

    Lee Williams is a professional writer, editor and content strategist with 10 years of professional experience working for global and nationally recognized brands. He has contributed to Forbes, The Huffington Post, SUCCESS Magazine, AskMen.com, Electric Literature and The Wall Street Journal. His career also includes ghostwriting for Fortune 500 CEOs and published authors.

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    Aflak Chowdhury
    Aflak Chowdhury

    Aflak Chowdhury

    Medicare Expert

    Aflak Chowdhury is a Medicare expert and independent insurance broker specializing in group health insurance. He has worked for major providers including Humana and Principal Financial Group and today works mainly in the small group market.

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  • Published: April 22, 2021
  • Updated: January 17, 2023
  • 4 min read time
  • This page features 9 Cited Research Articles
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APA Turner, T. (2023, January 17). Does Medicare Cover the Shingles Vaccine? RetireGuide.com. Retrieved June 9, 2023, from https://www.retireguide.com/medicare/services/vaccines/shingles/

MLA Turner, Terry. "Does Medicare Cover the Shingles Vaccine?" RetireGuide.com, 17 Jan 2023, https://www.retireguide.com/medicare/services/vaccines/shingles/.

Chicago Turner, Terry. "Does Medicare Cover the Shingles Vaccine?" RetireGuide.com. Last modified January 17, 2023. https://www.retireguide.com/medicare/services/vaccines/shingles/.

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Does Medicare Cover Shingrix?

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.

In previous years, your Shingrix shot would likely have a copayment or other out-of-pocket costs with a Medicare Advantage or Medicare Part D plan.  Starting on January 1, 2023, all adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) will be 100% covered with no deductible or cost-sharing for those with Medicare drug coverage. Shingles shots are on ACIP’s list of vaccine recommendations and guidelines.

What Is Shingles?
Shingles is the common name for herpes zoster, a skin rash with painful blisters that is caused by the same virus that causes chicken pox. Your body cannot shed the chickenpox virus, so it lives on in certain nerves in your body. If you’ve ever had chicken pox, you are at risk for shingles later in life. It’s not clear why the virus comes back as shingles.

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.”

Vaccines Covered by Medicare Part D Plans
  • 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 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.

Vaccines Covered by Medicare Part B

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 $212 for a total of $424, according to GoodRX in 2022. Discounts can lower that cost by nearly $30 per shot.

Medicare Part D and Medicare Advantage plans cover the cost of the Shingrix vaccine, along with the deductible and any potential cost-sharing.

 

How to Get Coverage for the Shingles Vaccine

While Original Medicare will not cover the shingles vaccine, there are other options for you to get coverage through either a Part D prescription drug plan or a Medicare Advantage plan.

Medicare Part D Coverage

Original Medicare doesn’t cover most prescription drugs, but you do have the option of purchasing a Part D plan. These plans are sold by private insurers and offer coverage for a range of prescription drugs.

While there is some variation in Part D plans since they are provided by different private companies, they typically must include coverage for Shingrix.

Medicare Advantage Plan

Another way to be eligible for coverage of the shingles shot is through a Medicare Advantage plan. Like Part D, Medicare Advantage is provided through private insurers.

The plans include, at minimum, everything that is covered under Original Medicare, and they also offer additional and expanded coverage as well. One of the most common forms of expanded coverage is prescription drugs, which means your shingles shot can be covered under many different Medicare Advantage plans.

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Where to Get the Shingles Vaccine

You have a few different options on where to get the shingles vaccine. You usually can receive it directly from your doctor at a doctor’s office or at a pharmacy.

The major pharmacy chains typically offer shingles shots so you should be able to get it at a location near you. You will still need a prescription from your doctor in order to get it at a pharmacy.

Who Can Administer Your Shingles Shot?
  • Your doctor
  • Your local pharmacy

The vaccine is administered as a shot to your upper arm. While the Shingrix vaccine is safe and effective at preventing shingles, there are some possible side effects. According to the CDC, you may experience some common mild symptoms associated with vaccines, such as arm soreness, muscle pain or a headache.

Remember that the vaccine comes in two doses, so you will have to return to wherever you got the shot two to six months later to receive the second dose. The immune reaction may come with the first or second dose, or with both doses of Shingrix.

Last Modified: January 17, 2023

9 Cited Research Articles

  1. U.S. Centers for Disease Control and Prevention. (2022, October 5). Reduced Drug Prices, Enhanced Medicare Benefits Under the Inflation Reduction Act Frequently Asked Questions (FAQs). Retrieved from https://www.cms.gov/files/document/10522-external-faqs-about-inflation-reduction-act.pdf
  2. U.S. National Library of Medicine. (2022, April 1). Shingles. Retrieved from https://medlineplus.gov/ency/article/000858.htm
  3. U.S. Centers for Medicare & Medicaid Services. (2022, January). 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
  4. 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
  5. 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
  6. 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
  7. AARP. (2020). Does Medicare Cover the Shingles Vaccine? Retrieved from https://www.aarp.org/health/medicare-qa-tool/does-medicare-cover-shingles-shot/
  8. GoodRx. (n.d.). Shingrix. Retrieved from https://www.goodrx.com/shingrix
  9. U.S. Centers for Medicare & Medicaid Services. (n.d.). Shingles Shots. Retrieved from https://www.medicare.gov/coverage/shingles-shots