Medicare is a health insurance program for older Americans that is administered by the federal government. Medicare Part A covers hospitalization, while Medicare Part B covers doctor’s visits and preventive care. Medicare Part D is a prescription drug plan. 

Does Medicare Part B Cover the Shingles Vaccine? 

Medicare Part B is the part of Medicare that covers doctor’s visits and preventive care. The shingles vaccine is considered a preventive care service, which means it should be covered by Medicare Part B. However, it is not. 

Why does Medicare not cover the shingles shot? 

There are a few reasons why Medicare Part A and Part B do not cover the shingles vaccine. One reason is that the vaccine is not considered to be medically necessary. Medicare only covers preventive care services that are considered medically necessary. Instead, your shingles shot will be covered if you have Medicare Part D, which covers prescription drugs. 

Another reason Medicare does not cover the vaccine is that it is not considered to be cost-effective. Medicare only covers preventive care services that are considered to be cost-effective. The shingles vaccine is not currently considered to be cost-effective by Medicare standards in some cases. 

Does Medicare Part D cover the shingles vaccine? 

Yes, Medicare Part D is usually able to cover all of the commercially available vaccines, including the shingles vaccine. So, if you are enrolled in Medicare Part D, then you may be covered for it. It’s important that you check your Medicare drug plan to learn whether it offers coverage for the shingles shot. 

Starting January 1st, 2023, the shingles vaccine will be available without deductible and cost-sharing for all Medicare Part D beneficiaries.

How to save money on the Medicare shingles vaccine? 

There are a few ways you can reduce the cost of a Medicare shingles vaccine, including through your Medicare prescription drug plan: 

Sign up for Medicare Part D 

Medicare Part D covers prescription drugs. During an open enrollment period, make sure to select a prescription drug plan that includes Tier 3 drugs. Shingrix is considered a Tier 3 drug. 

Go through a state pharmaceutical assistance program 

Medicare Part D plans have a yearly deductible. After you reach your Medicare Part D plan’s deductible, you will still be required to pay a copayment or coinsurance for your shingles vaccine. However, if you go through a State Pharmaceutical Assistance Program (SPAP), you may be able to get help with these costs. 

Go to an in-network pharmacy with a prescription 

For those who already have a prescription drug plan, going to an in-network pharmacy with a prescription for the shingles shot may help to reduce your costs. 

Does Medicare Advantage cover the shingles vaccine? 

Medicare Advantage plans are private health insurance plans that are approved by Medicare. Medicare Advantage plans must cover the same services as Medicare Part A and Part B, but they can also offer additional benefits. Some Medicare Advantage plans may cover the shingles shot, but it is not required. It is important to talk to your insurance broker or insurer to find out whether your Medicare Advantage plan will cover the vaccine. 

Medicare shingles vaccine cost  

The full cost of the shingles vaccine from Shingrix is $324, spread out across two shingles shots costing $162 each. If you have a prescription drug plan with Medicare, the approximate cost could be less than $50 per shot, a more than 60% discount from the full price! 

While the premium of the prescription drug plan may be higher than that of a Medicare Advantage plan, the prescription drug plan will likely save you money on the vaccine in the long run. 

Why do you need shingles shot? 

For older Americans, the shingles vaccine is an important way to protect against the herpes zoster virus. The virus can cause a painful rash and blisters. It can also lead to serious complications, such as pneumonia, brain damage, and even death. 

It is recommended that adults over the age of 60 get the vaccine. If you are over the age of 60, talk to your doctor about whether the shingles vaccine is right for you and let an insurance broker find the best Medicare shingles vaccine plan. 

Questions about Medicare?

Shoot us an email at medicare@hihella.com.