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Originally Posted On: Does Medicare Cover Shingles Vaccine? – Senior Affair
Need the shingles vaccine but asking yourself, “Does Medicare cover shingles vaccine?” In this Senior Affair article, we tell you everything you need to know.
According to the Centers for Disease Control, 1 out of 3 people in the United States will contract shingles in their lives.
While many only get it once, some people contract it multiple times. The rate of cases has been increasing over the years, and no one knows precisely why.
Shingles can impact anyone, young or old. However, it’s more common among the elderly population and also more problematic.
That said, getting the shingles vaccine, especially if you are elderly, immunocompromised, or both, makes sense.
But does Medicare cover the shingles vaccine?
The short answer is yes. Read on, and we’ll tell you everything you need to know.
Does Medicare Cover the Shingles Vaccine?
Yes. Although, how it covers the vaccine will depend on your specific coverage plan.
Suppose you have coverage under the Original Medicare Program, Medicare Part A (Hospital Insurance), and Medicare Part B (Medical Insurance). In that case, Medicare Part B will cover the cost of the visit but not the vaccine. So expect to pay for the vaccine out of pocket.
If you are enrolled in Medicare Part C (Medicare Advantage) and Medicare Part D (Prescription Drug Plans), then Medicare will cover both commercially available shingles vaccines. Shingrix and Zostavax.
Shingrix is the new shingles vaccine. Zostovox won’t be produced after July 2020. Some pharmacies may still have a supply available, but Shingrix is now the defacto shingles vaccine and is what the CDC recommends.
How Can I Get the Shingles Vaccine?
You can obtain the shingles vaccine in two ways; at your Primary Care Physician’s office or your pharmacy.
At Your Primary Care Physician’s Office
Before you go, check if you can bill your plan directly or via your pharmacy. If so, you will likely only need to pay your copayment. If they can’t or don’t bill out, you may need to pay for the total cost upfront and file for reimbursement.
Your copay will depend on your coverage stage.
Ask about the doctor’s fee for the administration of the vaccine. If it’s more than your allowable charge, you could end up footing the bill for the difference. If you check beforehand, it won’t be a surprise.
At Your Pharmacy
Most major pharmacy chains and some smaller, independent pharmacies can also administer the shingles vaccine. If you have Part D, this is where you’ll go.
You will still need a prescription from your doctor, and you’ll need to make sure that the pharmacy you choose is in your network. That way, they can bill your plan, and you’ll only be paying your copayment.
If you have to pay out of pocket, or your copayment is more than $155, you may be able to save money by using an app like Good Rx, or Medicine Assistance Tool, which is a database of programs available to help people pay for medicines they need.
It Pays to Protect Yourself
There you have it. Does Medicare cover the shingles vaccine?
Yes. Through Part B, Part C, and Part D.
Although Medicare Part D is optional, if you don’t sign up for it when you are first eligible and decide to sign up later, you could be fined.
Getting coverage for common vaccines, like shingles, makes it worth it even if you don’t take prescriptions.
Reach out to one of our trained professionals today, and we’ll help you get the coverage you need.