The shingles vaccine, called Shingrix, is a widely available vaccine to protect against shingles and postherpetic neuralgia. Adult over the age of 50 are recommended to get both doses of Shingrix to prevent occurence of disease. Medicare recipients fall into this category and should absolutely get the vaccine. If you have Medicare, you may be wondering: Does Medicare cover the cost of the shingles vaccine? Let’s dig in and find out!
- An overview of Medicare
- What Medicare is missing
- Is Shingrix covered by Medicare?
- How much does the shingles vaccine cost?
Medicare coverage explained
Medicare is health insurance for those eligible over the age of 65. Traditional Medicare is composed of two parts in its most basic form: Part A and Part B.
Medicare Part A covers hospital-based costs associated with an inpatient stay. Part A does not have a monthly premium, but does have deductibles and copays associated with certain services.
Medicare Part B covers outpatient services like doctors visits, imaging, and more. Part B typically has a premium around $150 at its base, but can skyrocket upwards if you have a higher income.
Why Medicare alone isn’t the best choice
Notable missing from parts A and B are all of the other aspects of healthcare including prescription drugs, vision insurance, dental insurance, and programs that promote general wellness.
I recommend Medicare Advantage to almost everyone over age 65 because most plans cover all of these things (and more) at little to no extra cost. Medicare Advantage is also called part C and includes Medicare Part D in most of its plans.
To learn more about Medicare Advantage, please check out my book on Amazon:
Does Medicare cover shingles shots for seniors?
No – traditional Medicare parts A and B do not cover the shingles shots for seniors. The shingles shot is covered at least partially with Medicare Advantage or Medicare Part D.
This is a sad reality for those over age 65 with Medicare who should have access to the vaccine for no additional cost. Medicare Part D comes at an extra cost if purchased separately, but is offered in most of the Medicare Advantage plans.
How much does a shingles shot cost with Medicare?
With Medicare Part D, the average cost for Shingrix is about $50 out of pocket per shot. The total for both shots averages $100.
Without Medicare Part D, the cost for each Shingles shot is nearly $206. You can bring the price of this down with GoodRx to $155. GoodRx is free and a great resource for situations like this.
Medicare Part D explained
Medicare Part D is a plan that is sold separately from traditional Medicare (A & B). Part D has a separate cost and provides prescription drug coverage. While it seems crazy to think that Medicare wouldn’t pay for prescriptions, its true.
Medicare Part D plans can be purchased from commercial health insurers as an add-on benefit. Searching “Medicare Part D plans” will yield thousands of advertisements about these plans, as insurers love to offer them.
How to pick a Medicare Part D plan
The most important part of picking a Medicare Part D plan is the formulary. A formulary is a list of drugs that are covered by the insurance plan. When looking through the formulary, make sure that any prescription drugs you take are offered in a Tier 1 or Tier 2 plan.
The tiers in the formulary dictate the coverage. The lower the tier, the better coverage and the cheaper the cost!
If you don’t have Part D how do else can you pay for prescription drugs and vaccines?
GoodRx and GoodRx Gold
Programs like GoodRx work by providing discounts to card holders in exchange for more business to specific pharmacies. GoodRx cards are obtained through their website, goodrx.com. A new program called GoodRx gold also provides even deeper discounts for a monthly membership fee.
To read more about GoodRx and find out how to save money on the shingles shot, follow this link.
Medicare Part C aka Medicare Advantage
Yep – my favorite thing in the world is Medicare Advantage. It is simply far superior to Medicare, supplemental Medicare, or any other combination of plans. Medicare Advantage plans come at very little (sometimes $0) extra cost per month. Part C plans typically include prescription drug coverage, wellness benefits, vision, dental insurance, and more.
Medicare Advantage plans are sponsored by commercial health insurers like Cigna, BCBS, and Humana. They work just like employer sponsored health insurance and use most of the same terminology. Most of these come in the form of a PPO or HMO.
With a Medicare Advantage plan, the shingles vaccine will most likely be free.
If you’re interested in learning more about Medicare Advantage and the changes happening in 2022, then you absolutely have to read my short guide available below:
The bottom line
As important as it is for seniors to get the Shingles vaccine, its equally important to make sure you are financially covered. While I recommend Medicare Advantage as a comprehensive plan to help with costs like these, you can pay out-of-pocket, use GoodRx, or purchase a Part D drug plan separately to help cover the costs.