Yes, it’s covered through Medicare Part D plans and Medicare Advantage plans with prescription drug coverage.
Medicare Advantage plans with prescription drug coverage and Medicare Part D plans, also known as Medicare drug plans, and Medicare Advantage plans with prescription drugs coverage both cover the shingles vaccine. This prevents shingles infections. It is approved for use by those 50 years and older. Original Medicare Part A and Part B doesn’t offer coverage.
Medicare drug plans and the Shingles vaccine
Medicare Parts A and B are government insurance plans that provide hospital insurance and outpatient insurance. Medicare drug plans, on the other hand, are private insurance policies that are developed by providers who have agreements with the federal government. If you are eligible for Medigap or Original Medicare and require prescription drug coverage, this policy might be right for you.
All Medicare drug plans include the shingles vaccine, along with any other vaccines commercially available that can prevent illness. However, the coverage levels, premiums and copayments as well as deductibles and coinsurance requirements differ. While you might find a policy that has a low, or even zero, drug deductible, others have deductibles in excess of $400. You could end up paying the full cost of the shingles vaccine if you don’t meet your deductible.
The final cost of the shingles vaccine will depend on the way your plan categorizes it in its formulary. This is the list of drugs that it covers. Shingrix is often a Tier 3 drug. This means that you will have to pay more than for generic drugs.
Can Medigap help?
Medigap, or Medicare Supplement Insurance, adds coverage to Original Medicare. These plans can be purchased through private insurance companies. While some Medigap policies from the past may have covered prescription drugs, Medigap policies that were sold after January 1, 2006 don’t cover drug coverage and won’t pay for the shingles vaccine.
Is Medicare Advantage covered for the vaccine?
Like Medicare drug plans, Medicare Advantage plans, otherwise known as Medicare Part C plans, are private insurance policies from providers that have contracts with the federal government. Each plan will have its own premiums, benefits and copayments.
Prescription drug insurance is included in Medicare Advantage plans. This includes the shingles vaccine. Some plans have a $0 drug deductible. You may be eligible for a separate Medicare plan if your Medicare Advantage plan does not include prescription drug coverage. This will help you cover vaccine costs.
How much does the shingles vaccine run?
The average retail price for a single dose of Shingrix, the shingles vaccine recommended by the CDC, is about $200, and the typical copay for patients who’ve paid their deductible but haven’t reached the drug expense threshold known as the donut hole or coverage gap can range from $0 to $164, according to the prescription drug coupon website GoodRx.
Discount coupons from GoodRx and similar companies may be available to help offset the cost for the shingles vaccine. People who have certain assets and income requirements may be eligible for the Part D Low Income Subsidy, or state pharmaceutical assistance programs that reduce out-of pocket costs.
Who should receive the shingles vaccine
The CDC recommends that all adults over 50 receive the two-dose Shingrix shingles vaccination. Because shingles can recur, this recommendation is also applicable to people who have had shingles before. The CDC advises against the vaccination in some cases, such as if there is a current shingles outbreak.
Ask your primary care provider if you are unsure if you should have the vaccine.