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Is the Shingles Vaccine Covered by Medicare?

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By Daniel Petkevich
Nov 17, 2022

The Shingles Vaccine: Your Questions Answered

Your immune system declines with age. As a result, you may get sick more often or take longer to recover.

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One particularly painful virus that affects older populations is shingles.
You can avoid shingles by getting vaccinated. But these vaccines can be expensive.
So what should you do? Is there a way for Medicare to cover your vaccination costs?
Let's find out.

What Is Shingles?

Shingles results from the same virus as chickenpox. Here's how it works:
  • When the virus enters your body for the first time, it causes chickenpox
  • The virus then stays in your body — even after your symptoms go away — and reappears as shingles later in life
Visual asset.
Shingles |

Cleveland Clinic

‎So, anyone who has had chickenpox is at risk of developing shingles. But adults ages 60+ account for more than half of the cases.
But unlike chickenpox, you can have shingles more than once.

Who Should Get the Shingles Vaccine?

CDC (Center for Disease Control and Prevention) recommends two doses of Shingrix — two or six months apart — for the following groups:
  • Anyone 50 years or older
  • Adults over the age of 19 who have weakened immune systems
But what if you've already had shingles or previously received a different shingles vaccine? Do you still need the Shingrix vaccine?
The simple answer: Yes.
The CDC clarifies that you should still get Shingrix even if you've had shingles, received Zostavax (a shingles vaccine no longer available in the U.S.), or received varicella (the chickenpox vaccine).
However, the CDC states that you should NOT get Shingrix if you:
  • Had a severe allergic reaction to a previous dose of Shingrix
  • Currently have shingles
  • Currently have a severe illness — with or without a fever
  • Are pregnant

Does Medicare Cover the Shingles Vaccine (Shingrix)?

Starting in January 2023 — per the new guidelines of the

Inflation Reduction Act

Medicare

Part D will cover 100% of the shingles vaccine (Shingrix). Beneficially, the act also includes full coverage for

all adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP)

. These include the Tetanus-Diphtheria-Whooping Cough and COVID-19 vaccines.

How Much Does the Shingles Vaccine Cost?

To recap: in 2023, the shingles vaccine will be free for all Medicare beneficiaries with Part D.
However, if you don't have Medicare yet, the exact cost depends on your plan, insurance provider, and pharmacy.

How Do I Get the Shingles Vaccine?

You can get your shingles shot at the following locations:
  • Local pharmacy — You can get vaccinated in any pharmacy that administers the shingles vaccine.
    • Visit a pharmacy within your plan's network. That way, the pharmacy can directly bill your plan.
  • Doctor's office — In 2023, you can get vaccinated in your doctor's office for free.

I Don't Have Medicare. What Are My Options?

First, if you're eligible, give us a call at

Fair Square Medicare

.
Here are a few different options that can help you pay for your vaccine:
    • To qualify for this program, you must be 18 or older, live in the United States or Puerto Rico, and meet certain income criteria.
    • You might also be eligible if you have Medicare Part D but have already spent $600 on medications through your plan.
  • Discount cards
    • Look out for discount coupons provided by

      GoodRx

      or

      SingleCare

    • Note: These discounts cannot be combined with your Part D benefits
  • Installment payments
    • Pay small amounts at a time if you can't afford the full price upfront
    • Talk to your doctor or check whether your pharmacy allows you to pay in installments

Takeaway

Starting in 2023, the shingles vaccine will be free for all Medicare beneficiaries with Part D. If you haven't yet received the vaccine, you can wait until January to get it for free.
However, if you've already received your first dose and need your second dose before next year, you can get coverage if you're on a prescription drug plan.
And if you're not sure where to start, don't worry!

Our team

is here to help. We'll answer any questions you might have about shingles, vaccines, and Medicare plans. Give us a call at 1-888-376-2028.

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Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

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Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2024 Help Button Inc

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