Medicare

Medicare and the Shingles Vaccine: Are You Covered?

Medicare and the Shingles Vaccine: Are You Covered?

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The shingles vaccine is covered under your prescription drug benefits through Medicare Part D or Medicare Advantage. However, your actual cost and coverage will depend on the specifics of your plan. If you don't have a prescription drug plan, the full price for two doses of the Shingrix vaccine is $324, and several cost-saving options can help you get Shingrix for less.

Does Medicare cover the shingles vaccine?

All Medicare prescription drug plans offer some level of coverage for the shingles vaccine. You will find this coverage under your Medicare Part D plan or a Medicare Advantage plan.

The amount you pay will vary based on your policy details and your deductible amount. For some enrollees, the shingles vaccine could be free, but others may pay full price if a deductible must be met before the cost-sharing benefits begin.

The shingles vaccine is not covered by Original Medicare (Medicare Part A or B). However, Medicare Part B may cover a doctor's visit to get a prescription for the shingles vaccine.

Most Medigap plans, also called Medicare supplement plans, don't cover the shingles vaccine because they don't include prescription drug coverage.

Medicare plan
Shingles vaccine coverage
Part A (hospital insurance)
No
Part B (medical insurance)
May cover the doctor's visit to get a prescription for the vaccine
Part C (Medicare Advantage)
Yes, because most of these bundled plans include drug coverage. (Coverage amounts will vary)
Part D (prescription drug plan)
Yes (drug coverage amounts will vary)
Medicare supplement (Medigap)
No

How much does the shingles vaccine cost with Medicare?

Most people who are enrolled in Medicare Part D pay less than $50 per dose for Shingrix, according to the vaccine's manufacturer GlaxoSmithKline. However, your costs will vary based on the plan's details and if you've already met your deductible amount by purchasing other prescription drugs.

For example, some seniors can get the shingles vaccine for free because it's fully covered by their Medicare Part D or Medicare Advantage plan. Others may have to pay a portion of the cost, such as a $50 copay per shot, or pay full price if the deductible hasn't been met.

If you don't have a prescription drug plan or you haven't met your plan's deductible, the retail cost for the shingles vaccine is $162 per shot in 2021. For the two-dose sequence, the total cost is $324. If the full price of the shingles vaccine is out of your budget, there are several ways you can save money on the vaccine.

About the shingles vaccine

The Centers for Disease Control and Prevention (CDC) recommends that healthy adults over the age of 50 get the shingles vaccine because it's the only way to protect against the disease and its associated side effects. The risk of getting shingles increases as you age or if you have a weakened immune system. Always consult your doctor to find out if the shingles vaccine is right for you.

The CDC recommended vaccine, Shingrix, is a recombinant zoster vaccine that has two doses administered within six months of each other. It's classified as a Tier 3 drug by most insurance companies, which means it's a brand-name pharmaceutical with a higher copayment than a Tier 1 or 2 drug.

Use the Shingrix vaccine locator to find where the shingles vaccine is being offered, and check with your Medicare Part D or Medicare Advantage provider to see which locations give you the lowest price.

Which Medicare providers cover the shingles vaccine?

Even though all insurance plans for Medicare Plan D offer some level of coverage for the shingles vaccine, the typical cost for the vaccine will vary. Your actual cost will depend on your plan details and if you've already met your deductible.

Company
Typical shingles vaccine cost
AARP Medicare$45-$160
Aetna Medicare$47
Anthem Blue Cross Medicare$31-$149
Cigna Medicare$35-$159
Humana Medicare$42-$159
Kaiser Permanente$150
SilverScript Medicare$59-$77
Tufts Medicare$0-$151
UnitedHealthcare Medicare$160
WellCare Medicare$28-$47

Typical costs based on available plans in Charlotte, NC (AARP, Aetna, Cigna, Humana, SilverScript, UnitedHealthcare), Boston, MA (Tufts, WellCare), and Los Angeles, CA (Anthem Blue Cross, Kaiser Permanente)

How does your Medicare deductible affect your vaccine costs?

The deductible amount of your Medicare plan affects how much you pay out of pocket before your insurer starts contributing to the cost of your prescription drugs. Depending on how many medications you take, the deductible could affect how much you spend on the vaccine. Let's compare how much you'd pay for the shingles vaccine on two plans with different deductibles.

Scenario: Shingrix is the only medication needed during the policy

AARP MedicareRx Walgreens
AARP MedicareRX Preferred
Monthly cost for premiums$39$86
Deductible amountNo deductible for Tier 1 and 2 drugs; $455 deductible for drugs classified as Tier 3, 4 or 5No deductible
Cost of two doses of Shingrix vaccine (Tier 3 drug)$160 each for a total of $320 because the deductible hasn't been met$45 copay each for a total of $90
Total annual cost of premiums and shingles vaccine$788 ($332 savings)$1,122

In the example above, the AARP MedicareRx Walgreens prescription drug plan has a $455 deductible for Tier 3 drugs like the shingles vaccine. That means if you haven't already met your deductible, you would pay full price for the vaccine, which would be $320 for two doses. The plan costs $38.60 per month for someone living in Charlotte. If the shingles vaccine is the only Tier 3, 4, or 5 drug needed during the policy year, your total annual spending would be $788.

With a no-deductible prescription drug plan like the AARP MedicareRX Preferred, you'll pay more each month, but the cost of the shingles vaccine would be just $45 each because there is no deductible to meet. The plan costs $86 per month for someone living in Charlotte, N.C., and along with the $90 copay for two doses of the shingles vaccine, the total annual cost is $1,122.

In this situation, the person with the MedicareRx Walgreens plan pays less overall, even though they're paying full price for the shingles vaccine.

Keep in mind that this comparison is only looking at the cost of the shingles vaccine and isn't taking into consideration any other medication costs. If you regularly take prescription drugs, the best prescription drug plan for you could be one like the MedicareRX Preferred that has a higher monthly cost, but the benefits kick in sooner.

How can you save on the cost of the shingles vaccine?

These five tips can help you to pay less for a shingles vaccine.

  1. Visit an in-network pharmacy with a prescription: If you have a prescription drug plan, you could pay less for your vaccine by having it administered at an in-network pharmacy. Getting the shot at a doctor's office may lead to an additional doctor's fee for administering the vaccine.
  2. Sign up for Medicare Part D or improve your drug coverage: During open enrollment, you can select a prescription drug plan that covers Tier 3 drugs including Shingrix. Remember to consider the total policy costs for all of your prescriptions. Also, if you receive a low-income subsidy, Medicare Part D plans could be available for free.
  3. Get a discount coupon for the shingles vaccine: Pharmaceutical retailers and networks may offer vaccine discounts. Usually, you'll present the coupon or the drug discount card at the pharmacy to get the savings.
  4. Use a state pharmaceutical assistance program: A state program may be available to help you reduce the cost of prescription drugs including the shingles vaccine.
  5. Get assistance from the vaccine maker: GlaxoSmithKline offers the GSK Patient Assistance Program for those who meet certain criteria, and you may qualify if you earn less than $32,200.

Why doesn't Medicare cover the shingles vaccine as free for all seniors?

Many people think that a vaccine that's recommended by the CDC for those over age 50 would be fully covered by Original Medicare. However, there are a few reasons why you may end up paying hundreds of dollars for the two-dose regimen.

  • Medicare coverage levels: Some Medicare drug plans have better cost-sharing benefits than others, and how much you pay for the shingles vaccine will depend on the plan you choose.
  • Pharmaceutical classification: Medicare classifies the Shingrix vaccine as a part of its pharmaceutical coverage, meaning it would fall under Medicare Part D coverage rather than Part A or Part B. In contrast, most private health insurance, either through an employer or through the marketplace, classifies the shingles vaccine as a part of its free preventative coverage.
  • Type of pharmaceutical: Shingrix is a Tier 3 drug made by GlaxoSmithKline, and there isn't a generic alternative. This could mean that your out-of-pocket costs are higher than other medications.

Frequently asked questions

What's the cost of the shingles vaccine?

The full cost of Shingrix is $162 per shot, totaling $324 for the recommended two doses. Many people with Medicare pay less than $50 per shot, and your coverage amount will depend on your prescription drug plan.

Is the shingles shot free for seniors?

The shingles vaccine is not free for all seniors, and how much you pay will depend on your Medicare Part D plan or with your Medicare Advantage prescription drug benefits. Seniors who don't have a prescription drug plan will have to pay full price for the shingles vaccine or use a cost-saving method to get the vaccine at a discounted price.

Does Medicare cover shingles and pneumonia vaccines?

The pneumonia vaccine is fully covered by Medicare Part B at zero cost. The shingles vaccine falls under your prescription drug plan, and you could be covered if you have Medicare Part D or a Medicare Advantage plan that includes Part D.

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