Does Medicare cover the shingles vaccine?

Currently, the shingles shot is covered by Medicare Part D and Medicare Advantage plans with Medicare Part D prescription drug coverage, but not under Original Medicare (Parts A and B).

Starting January 2023, people with Medicare Part D prescription drug coverage won’t pay any out-of-pocket costs for the shingles vaccine.*

Here’s some helpful information on the symptoms and causes of shingles, Medicare coverage of the vaccine and where to get a shot.

What is shingles?

Shingles is a viral infection caused by the same virus as chicken pox—the varicella-zoster virus. It starts as a painful rash on one side of the face or body and develops into blisters. The blisters continue to form over 3–5 days and eventually dry and crust over. Healing can take between 2–4 weeks, but shingles can leave scars and permanent pigmentation changes.1

Is the shingles shot covered by Medicare?

Original Medicare (Parts A and B) does not pay for the shingles vaccine. However, if you’re enrolled in a Medicare prescription drug plan (Part D) or have a Medicare Advantage plan (Part C) that includes Medicare Part D drug coverage, your shot may be covered. The shingles shot will be fully covered for everyone with Medicare Part D drug coverage starting January 2023.

What shingles vaccines are available?

Shingrix is the vaccine recommended by the Centers for Disease Control and Prevention (CDC) to prevent shingles and its complications. Healthy adults 50 years and older should get 2 doses of Shingrix, 2–6 months apart.2

Where do you get a shingles shot?

You can generally get a shingles shot at most pharmacies. To get the shot at a pharmacy, you may need a doctor’s prescription.**

To find Humana in-network doctor’s offices or pharmacies near you that offer the vaccine, use Humana’s Find a doctor tool.

How much does the shingles shot cost?

For now, the cost of the shot can depend on your Medicare plan, the vaccine type and where you get it. Most require a copayment, which can vary widely from plan to plan. If you haven’t met your plan’s deductible for the year, you may have to pay full price.

Starting in 2023, the shingles vaccine will be 100% covered for those who have prescription drug coverage as part of a Medicare Part D plan or Medicare Advantage plan with prescription drug benefits.

Protect yourself

The CDC recommends that all healthy adults 50 years and older get vaccinated against shingles. If you have any additional questions, contact your healthcare provider for more information.

*Applies to Humana covered Part D vaccines listed on the Advisory Committee on Immunization Practices (ACIP) list. Restrictions based on age and vaccine availability may apply. For more information regarding the Centers for Disease Control and Prevention’s ACIP vaccine recommendations, please go to http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/index.html.

**Depending on your plan, the location where you receive the vaccine may impact coverage. Check your Explanation of Benefits (EOB) to learn if the vaccine is covered at your healthcare provider’s office, local pharmacy or both.

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Sources

  1. “Shingles (Herpes Zoster): Clinical Overview,” Centers for Disease Control and Prevention, last accessed October 10, 2022, https://www.cdc.gov/shingles/hcp/clinical-overview.html.
  2. “Shingles Vaccination,” Centers for Disease Control and Prevention, last accessed October 10,2022, https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html.