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Medicare Coverage for Shingles


All Medicare prescription plans cover shingles vaccines. If you believe you may have shingles, Part B pays for a visit to the doctor.

If your doctor prescribes antiviral or pain medications, Medicare prescription drug plans will usually cover them.

In the context below we’ll discuss coverage and costs for everything relating to shingles with Medicare.

Does Medicare Cover the Shingles Vaccine?

It’s probably been many years since you had chickenpox, but the virus has remained in your body all this time. As you get older, there’s an increased risk that the virus will reappear as shingles–a blistery rash that can cause burning pain long after your skin clears up.

Fortunately, there’s a vaccine that can prevent shingles. Because older adults are most at risk, the Centers for Disease Control and Prevention recommends a shingles vaccine for everyone over age 50.

Shingrix Vial Kit

There are two different shingles vaccines. The CDC recommends the newer of the two vaccines, Shingrix. However, the older vaccine, Zostavax, is still available.

Medicare Part B covers some recommended vaccines, but it doesn’t pay for a shingles vaccine. However, all Medicare prescription plans must cover both types of shingles vaccines.

Does Medicare Pay for the Shingles Shot?

If you have Medicare with a separate Part D plan, your prescription coverage will include shingles shots.  Several companies sell prescription plans, and each has its own deductibles, copays, and network of preferred pharmacies.

  • If you get your shot at a preferred pharmacy, your pharmacy will bill Medicare, and you’ll pay any deductibles or copays.
  • At a pharmacy outside your plan’s preferred network, you’ll pay more.
  • If you get a shot at your doctor’s office, your doctor may be able to work with a pharmacy to bill Medicare directly. Or you may have to pay up-front and ask Medicare to reimburse you. Be aware that your doctor’s fee for administering the vaccine may be more than your prescription plan will pay.

Often the most cost-effective way to get a shingles vaccine is to get a prescription from your doctor and then go to a pharmacy in your plan’s network to get your shot.

Medicare Part B Coverage for Shingles Treatment

Shingles appear as a painful rash on one side of your body. You may feel pain, itching, or tingling before the rash develops, and you may also have a fever, headache, or upset stomach. The rash turns into blisters that usually scab up within a week to 10 days.

If you believe you have shingles, it’s best to see a doctor right away. Prescription antiviral medications can shorten the illness and make it less severe, but they work best if you start taking them as soon as possible after the rash appears. If your pain is severe, your doctor may also prescribe pain medication or give you a corticosteroid injection.

Part B covers a visit to a doctor or urgent care center. It also covers any injections you receive at the doctor’s office. If you have a Medicare Supplement plan, you may not have to pay anything out of pocket to see a doctor for shingles.

If you have a Medicare Advantage plan, Part B will still cover doctor visits and injections. But you’ll have different costs than if you had Medicare.

Does Medicare Advantage Cover a Shingles Vaccine?

If you have a Medicare Advantage plan with prescription coverage, then the shingles vaccine will be covered. If you don’t have prescription coverage, you’ll have to pay for the vaccine yourself.

As with traditional Medicare, the cost of the vaccine can vary by plan. You’ll save money by getting your vaccine from a pharmacy in your plan’s network.

Prescription Drug Coverage and Shingles Treatment

Your doctor may prescribe antiviral drugs such as famciclovir, valacyclovir, and acyclovir. These drugs can help the rash heal more quickly and reduce the chance you’ll suffer serious side effects. If your pain is severe, your doctor may also write you a prescription for pain medications.

Medicare prescription plans typically cover both antiviral and pain medications, though the specifics will depend on your plan. You may have to pay a deductible or copay.

Your doctor may also suggest over-the-counter remedies such as lidocaine patches and Tylenol. Prescription plans don’t cover over-the-counter medications, even if your doctor recommends them.

CVS Shingles Vaccine

CVS offers the Shingles Vaccine at over 9,000 locations. The average cost is over $180. But, in some cases, it could be lower or higher.

Shingrix can prevent shingles in adults over the age of 50, but it doesn’t treat shingles symptoms that already began. The drug is for prevention.

FAQs

Does Medicare cover the zoster vaccine?
The virus that causes shingles are known as herpes zoster, and the shingles vaccine is sometimes called the zoster vaccine. There are two varieties of shingles vaccine: Zoster vaccine live (Zostavax) and recombinant shingles vaccine (Shingrix).

Part D prescription plans cover both vaccines, but you may have to pay a deductible or copay. The same is true of Medicare Advantage prescription plans.

Is Shingrix covered by Medicare?
Shingrix is the newer of the two shingles vaccines, and it’s recommended over the older Zostavax vaccine. Shingrix is administered as two shots, spaced two to six months apart, and it has a greater than 90 percent success rate at preventing shingles.

All Medicare prescriptions plans –both standalone plans and Medicare Advantage plans–must cover Shingrix. However, your plan may not pay the full cost of the vaccine.

What are the shingles shot costs with Medicare?
Your cost for shingles shot depends on the type of Medicare coverage you have. If you don’t have a prescription drug plan or a coupon, you’ll pay the full price of the shot– about $190, according to GoodRx.

If you do have a prescription plan, your cost will depend on your plan. You can contact your plan ahead of time for an estimate of what you’ll pay.

Does Medicare pay for the new shingles shot?
The newer of the two shingles shots, Shingrix, has been in use since 2017. It’s covered by all Medicare Part D prescription plans, and by prescription plans included in Medicare Advantage coverage.

Get Help with Medigap Coverage for Shingles

If you get shingles, you could have a long road to recovery – and significant out of pocket expenses for doctor bills. A Medigap plan helps by paying the portion of your bill that Medicare doesn’t pay.

At MedicareFAQ, we can answer all your questions about Medigap and help you find an affordable plan.

To get started, give us a call at the number above. Or, fill out our form

Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

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