Both Medicare Part D plans — also called Medicare drug plans — and Medicare Advantage plans with prescription drug coverage cover the shingles vaccine, which prevents shingles infections and is approved for use by people 50 and older. Original Medicare (Part A and Part B) doesn’t provide coverage.
Medicare drug plans and the shingles vaccine
Unlike Medicare parts A and B, which are government insurance plans that cover hospital insurance and outpatient medical insurance, respectively, Medicare drug plans are private insurance policies developed by providers that have contracts with the federal government. You might purchase such a policy if you have Original Medicare or a Medigap plan and need prescription drug coverage.
While all Medicare drug plans cover the shingles vaccine — along with all commercially available vaccines that are reasonable and necessary to prevent illness — the coverage levels, premiums, copayments, deductibles and coinsurance requirements vary. For instance, while you may find a policy with a very low or even a $0 drug deductible, many have drug deductibles over $400. If you haven’t met your deductible, you may end up paying full price for the shingles vaccine.
Your final cost will also depend on how your plan classifies the shingles vaccine in its formulary, the list of drugs it covers. Shingrix is often classified as a Tier 3 drug, one of the most expensive tiers, which means you’ll have to pay much more than you would for a generic drug.
Can Medigap help?
Medigap, or Medicare Supplement Insurance, adds coverage to Original Medicare. Such plans are sold through private insurers. Although some older Medigap policies may cover prescription drugs, any Medigap policies sold after Jan. 1, 2006, don’t include drug coverage and won’t help pay for the shingles vaccine.
Does Medicare Advantage cover the vaccine?
Like Medicare drug plans, Medicare Advantage plans, otherwise known as Medicare Part C plans, are private insurance policies from providers that have contracts with the federal government. This means each plan has its own set of premiums, benefits, copayments, deductibles and coinsurance.
Medicare Advantage plans with prescription drug insurance also cover the shingles vaccine. Some plans even have a $0 deductible for drugs. If your Medicare Advantage plan doesn’t include prescription drug coverage, you may be eligible to purchase a separate Medicare drug plan to help cover vaccine costs.
What does the shingles vaccine cost?
The average retail price for a single dose of Shingrix, the shingles vaccine recommended by the CDC, is about $200, and the typical copay for patients who’ve paid their deductible but haven’t reached the drug expense threshold known as the donut hole or coverage gap can range from $0 to $164, according to the prescription drug coupon website GoodRx.
You may be able to offset the cost of the shingles vaccine with discount coupons from GoodRx or other similar companies. Those who meet certain income and asset requirements may also qualify for programs such as the Part D Low-Income Subsidy or state pharmaceutical assistance programs to reduce out-of-pocket costs.
Who should get the shingles vaccine?
The CDC recommends that adults age 50 and older receive the two-dose Shingrix shingles vaccine. This recommendation extends to those who’ve had shingles in the past, since shingles can sometimes reoccur. However, the CDC recommends against getting the vaccine in certain cases — for instance, if you’re currently experiencing a shingles outbreak.
If you’re unsure about whether you should get this vaccine, ask your primary care provider.