Is the Shingles Vaccine Covered by Medicare?
Fair Square Medicare

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 (also known as herpes zoster) is a viral infection. It causes painful rashes or blisters on the skin that can last for weeks or months.

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

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 ActMedicare 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:

  • GSK Patient Assistance Program for Vaccines

    • 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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