Does Medicare pay for shingles vaccines?

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Neither Part A, which is hospital insurance, nor Part B, which is medical insurance, covers the shingles vaccine.

Part D does cover it, but people with Part D may be responsible for a portion of the cost, called the copayment.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

• Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
• Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
• Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

Under some Medicare Part D plans, people may need to pay the entire cost of the shot at the time of getting it. When this happens, Medicare will reimburse them later up to the plan’s allowable charge.

If the provider charges an amount that exceeds the allowable charge, the person is responsible for the difference.

To prevent an unexpected expense, an individual may wish to check the allowable charge for vaccines that their Medicare Part D plan offers before getting the shot. They can compare it with the amount that the provider charges to check whether they will need to contribute to the cost.

Until November 2020, two shingles vaccines were available: Shingrix and Zostavax. However, experts recommended Shingrix over Zostavax because it offered stronger protection. The manufacturer of Zostavax has now discontinued the production, sale, and use of this drug in the United States.

Many private health insurance plans cover the Shingrix vaccine, but some do not cover the entire cost, according to the Centers for Disease Control and Prevention (CDC).

Most Medicare patients pay less than $50 out-of-pocket for the vaccine. However, a person could pay as much as $200 for their shingles shot, depending on their specific Medicare plan.

It is possible for some people who have neither Medicare Part D nor private insurance to get the shingles shot, and some drug companies even provide it free of charge. People who are unable to afford the shot should ask a doctor about this possibility.

People may get the shingles vaccine at a doctor’s office or, if they have a prescription, at a drugstore.

Who should not get the shingles vaccine?

The vaccine may not be appropriate for people who have a weakened immune system due to certain conditions. These people include those with an organ transplant and those who are undergoing chemotherapy to treat cancer.

Doctors also recommend that people with an allergy to any component of the vaccine do not have the shingles vaccination.

Anyone with severe allergies must tell a doctor about them when discussing their shingles risk. People who are pregnant or breastfeeding or currently have shingles symptoms should not get the shot.

Complications of shingles

Sometimes, shingles can cause complications. The most common complication is long-term nerve pain, called postherpetic neuralgia, in the area of the rash. This pain, which can be severe, may decrease within a few weeks or months, but some people might continue to experience it years later.

Some people develop shingles on the face. If the condition affects the eyes, it can occasionally result in temporary or permanent vision loss. If the rash appears within or near the ear, the person is at risk of hearing or balance problems.

Medicare Part D covers the shingles vaccine, but people with these plans may be responsible for a copayment, which can vary depending on the plan and the provider.

Many private health insurers also cover part of the shot’s cost. People with a low income who do not have Medicare or private insurance may be able to get the shingles vaccine at no cost from certain drug companies.

The shingles vaccine is very effective, and the side effects are usually mild. Due to this, doctors advise healthy older adults to get the shot.