Shingles Vaccine and Medicare-Is it Covered?

The CDC recommends that everyone over the age of 50 get the Shingles vaccine. But is it covered by your insurance?

What is the Shingles?

The shingles is related to the chicken pox but they are not the same disease. With the Shingles you’ll develop a very painful itchy rash that can last up to five weeks! It’s estimated that around 1 million Americans suffer from the shingles every year. Risk and severity increase with age. It can even result in possible nerve damage. This is why the CDC recommends all adults over 50 get vaccinated.

When Should I Get the Vaccine?

If you’re still working, your best bet is to get the Shingles vaccine before you retire. ACA plans and group health insurance will cover the vaccine at no cost! So, if you’re eligible for the vaccine, but haven’t yet enrolled in Medicare, don’t wait!

Will Medicare Cover the Shingles Vaccine?

Many are surprised to learn that Original Medicare does not cover the shingles vaccine. Luckily Medicare Part D does. Additionally Part C plans which offer prescription drug coverage will also cover the Shingles vaccine, usually Shingrix. Read your Part D plan carefully to make sure your vaccine is covered and you are receiving the vaccine at an in network pharmacy.

Where Should I Get the Vaccine?

Get your shot at an in network pharmacy. If you go out of network, you may not be covered. There are two doses of the Shingles vaccine which average about $200 per shot. Without coverage your bill may be about $400. Additionally, do NOT get the shot at your doctor’s office. This will most likely result in a billing headache for you. Doctors usually bill Part B which does not cover the vaccine. The claim will be denied and kicked back to you. You’ll probably have to pay out of pocket until you can sort things out with your Part D plan.

Time Your Deductible to Save Money!

Even though the Shingles vaccine is covered, you’ll still need to meet your deductible. In 2022, the max deductible for any Part D plan is $480. If you haven’t met your deductible yet, you’ll need to pay out of pocket for the vaccine until you do so. Remember, your deductible resets yearly. Shingrix recommends that the second dose be administered between 2-6 months after the first shot. Try to time it so that you’ve already met your deductible to save money.

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Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.

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