Does Medicare Pay For Shingles Vaccine?

What is Shingles?

Shingles is a viral infection that causes a painful rash and blisters. The same virus that causes chickenpox gives you shingles. You can have an outbreak anywhere on your body, and it may take weeks or months to recover.

Shingles mostly affects older adults or those with weakened immune systems. Typically, adults over age 50 receive the shingles vaccine.

Fortunately, there is a vaccine for shingles. It can prevent or lessen the effects of the shingles virus.Does Medicare Pay For the Shingles Vaccine?

Yes. You might be surprised to know Medicare Part D covers the shingles vaccine, not Medicare Part B.

In the US, there are nearly 1 million new cases of shingles each year, so your doctor is likely to recommend you receive the vaccination.

Where Can I Get a Shingles Vaccine?

Fortunately, it's relatively easy to find a vaccine provider. You can get a shingles vaccine from a pharmacy in your Medicare Part D network.

Alternatively, your doctor may provide a shingles vaccine during your visit. If so, tell the doctor's office to bill your Medicare Part D plan directly. Medicare Part B (doctor's appointments and preventative care), does not cover the shingles vaccine. In this case, you must submit a reimbursement request to Medicare.

You can rest assured that Medicare will cover your shingles vaccine because it requires all part D plans to include it.

How Much Will I Pay for the Shingles Vaccine?

Most Medicare Part D plans cover 50% or more of the vaccine cost. Check which vaccine brand your policy covers by checking the Part D drug formulary (guide). When you determine in which tier the vaccine is, you will know how much your plan pays.

Also, the amount you pay depends on which brand of shingles vaccine you receive: Zostavax or Shingrix.

Zostavax requires only one injection. In 2018, the average cost was $220. If your Part D plan pays 50%, you will pay $110 out-of-pocket.

Shingrix requires two injections, 2 to 6 months apart. In 2018, the average cost was $140 per dose, or $280 total. If your Part D plan pays 50%, you will pay $140 out-of-pocket.

If you have a Medicare supplement, Medicare Advantage plan, or private health insurance, you may pay less out-of-pocket.

Does Medicare Cover Shingrix?

Yes, all Medicare Part D plans, and Medicare Advantage plans (with Part D coverage) pay for the Shingrix shingles vaccination.

If you pay for this vaccine yourself, ask the pharmacist if they require a prescription. You may not need one. If you do, contact your doctor and request they send an order to your pharmacy.

If I Had the Chickenpox Vaccine, Do I Need a Shingles Vaccine?

If you ever contracted chickenpox, you have a higher risk of getting shingles. In most people, the chickenpox virus stays dormant, so it never leaves your system. Shingles reawakens the same virus that caused chickenpox.

Fortunately, shingles cannot be passed from one person to another, unlike the highly contagious chickenpox. So, someone who never contracted chickenpox can get it from a person with shingles.

However, if you received a chickenpox vaccine and never contracted it, you have a low risk for shingles.

Do Seniors Experience Pain and Complications with Shingles?

Unfortunately, most seniors experience pain and complications if they have shingles.

In fact, many seniors believe it's more painful and persistent than the chickenpox they remember from childhood.

You might experience symptoms like rashes, blisters, numbness, tingling, and even flu-like symptoms. More rarely, it can lead to pneumonia, hearing problems, blindness, encephalitis, or death.

Because the virus attacks the nervous system, pain can last for some time after the skin clears up.

Where Can I Buy a Medicare Supplement that Covers the Shingles Vaccine?

AARDY is the nation's fastest Medicare insurance marketplace. You can compare Medicare supplements and Medicare Advantage plans to find the one that best fits your needs.


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