Medicare and the Shingles Vaccine: Are You Covered?
Most people who have Medicare can get the shingles vaccine for free.
As of 2023, the shingles vaccine is fully covered through Medicare Part D or Medicare Advantage as part of your prescription drug benefits. Even if you previously paid a copay for the shingles vaccine, it's now available at no cost, even if you haven't met your plan's deductible.
If you don't have Medicare prescription drug coverage or you don't yet qualify for Medicare, the full price for two doses of the Shingrix vaccine is $367.
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How much does the shingles vaccine cost with Medicare?
The shingles vaccine is free for nearly everyone, including those who have a Medicare prescription plan, Medicaid, a marketplace health insurance plan (Obamacare) and most employer insurance plans.
Previously, how much you paid for a shingles vaccine was determined by your prescription benefits, and Medicare enrollees paid an average of $77 for the shingles vaccine. But the Inflation Reduction Act changed the rules, and recommended vaccines are now available at no cost, even if you haven't met your plan's deductible.
Free shingles vaccines are part of a recent rule change. So if your plan documents say there should be a cost, contact your insurance company to confirm that the coverage information has been updated.
If you don't have a prescription drug plan, the retail cost for the shingles vaccine is $183 per shot. For the two-dose sequence, the total cost is $367, according to the vaccine's manufacturer GlaxoSmithKline (GSK). If the full price of the shingles vaccine is out of your budget, there are several ways you can save money on the vaccine.
The Centers for Disease Control and Prevention (CDC) recommends that healthy adults over the age of 50 get the shingles vaccine because it's the only way to protect against the disease and its associated side effects. The risk of getting shingles increases as you age or if you have a weakened immune system. Always consult your doctor or pharmacist to find out if the shingles vaccine is right for you.
The CDC-recommended vaccine, Shingrix, is a recombinant zoster vaccine that has two doses administered within six months of each other. According to the manufacturer, 95% of privately insured people can get the shingles vaccine for free.
Use the Shingrix vaccine locator to find out where the shingles vaccine is being offered.
How can you save on the cost of the shingles vaccine?
- Stay in-network: To get the shingles vaccine for free, you’ll usually need to get the shot from one of your plan's in-network pharmacies or doctors.
- Watch out for billing issues at the doctor's office: If you get the vaccine at the doctor’s office, check that you won’t have to pay the full cost of the vaccine and get reimbursed later by the health insurance company. Also, some doctors charge a vaccine administration fee, which would be billed at your insurance plan's rates, such as a 20% copay.
- Sign up for Medicare Part D if you don't have prescription coverage: During open enrollment each fall, those who are eligible for Medicare can enroll in a prescription drug plan. When choosing a plan, consider the total costs for all of your prescriptions. Also, if you receive a low-income subsidy, Medicare Part D plans could be available for free.
- Look for discounts if you don’t have Medicare drug coverage: If you're not eligible for a free shingles vaccine, you can use a state pharmaceutical assistance program to help you reduce the cost of prescription drugs including the shingles vaccine. There are also pharmacy discount programs where you can present the coupon or the drug discount card at the pharmacy to get the savings.
Does Medicare cover the shingles vaccine?
All Medicare prescription drug plans offer full coverage for the shingles vaccine.
You will find this coverage under your Medicare Part D plan or a Medicare Advantage plan. Recommended Tdap vaccination is also available at no cost.
Medicare plan | Shingles vaccine coverage |
|---|---|
| Part A (hospital insurance) | |
| Part B (medical insurance) | |
| Part C (Medicare Advantage) | |
| Part D (prescription drug plan) | |
| Medicare Supplement (Medigap) |
The shingles vaccine is not covered by Original Medicare (Medicare Part A or B). However, other vaccines such as those for flu and hepatitis B are fully covered under Medicare Part B.
Medigap plans, also called Medicare Supplement plans, don't cover the shingles vaccine because they don't include prescription drug coverage. Vaccines are considered a type of prescription drug.
Frequently asked questions
What's the cost of the shingles vaccine?
If you have a Medicare prescription drug plan, the shingles vaccine is free as of 2023. There is no copay, and you don't have to meet your plan's deductible before it's covered. Without Medicare drug coverage, the full cost of Shingrix averages $183 per shot, or $367 for the recommended two doses.
Is the shingles shot free for seniors?
Yes, the shingles vaccine is now free for all seniors with a Medicare prescription drug plan. Because of a 2023 rule change, your costs no longer depend on which drug plan you have. All plans provide $0 shingles shots.
Does Medicare cover shingles and pneumonia vaccines?
The pneumonia vaccine is fully covered by Medicare Part B at zero cost. The shingles vaccine is also free, but this coverage is through your prescription drug plan, either Medicare Part D or a Medicare Advantage plan that includes prescription benefits.
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Key Takeaways:
The shingles vaccine is free for almost everyone with health insurance
Without insurance, two doses of the shingles vaccine are $367
If you don't have insurance, check for coupons to save on cost
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