Paul Barrett Insurance Services Blog
Do Medicare Part D plans cover the shingles vaccine? SPECIFICALLY Shingrix®?
Yes. Medicare Part D prescription drug plans do cover the shingles vaccine (stand-alone Medicare Part D plans and Medicare Advantage plans that include drug coverage). However, coverage (and cost) of the vaccine can vary depending on your chosen Medicare prescription drug plan, vaccine, and the pharmacy where you have the vaccine administered.
Coverage of the Shingrix® vaccine -- Update May 1, 2018:
Please note, the new shingles vaccine Shingrix® (approved by the FDA in October, 2017), is now available on most Medicare Part D plans and Medicare Advantage plans that include drug coverage.
"CDC recommends that healthy adults 50 years and older get two doses of the shingles vaccine called Shingrix®, separated by 2 to 6 months, to prevent shingles and the complications from the disease. Your doctor or pharmacist can give you Shingrix as a shot.
Shingrix provides strong protection against shingles and postherpetic neuralgia (PHN). Two doses of Shingrix® is more than 90% effective at preventing shingles and PHN. Protection stays above 85% for at least the first four years after you get vaccinated. Shingrix is the preferred vaccine, over Zostavax®, a shingles vaccine in use since 2006."
(source: https://www.cdc.gov/ vaccines/vpd/ shingles/public/ shingrix/index.html)
If Shingrix® is not on your Medicare Part D plan drug lists (formularies), please speak with your Medicare Part D plan's Member Services department and ask when the plan will be adding Shingrix® to their formulary.
Medicare Part A and Medicare Part B does not cover Shingles Vaccine.
Please note, Medicare Part B (out-patient care) does not cover the shingles vaccine, but you can have your doctor administer the vaccine in their office Your doctor probably cannot charge your Medicare Part D plan for the vaccine, so you can pay your doctor out of pocket, and then ask your Medicare Part D plan to reimburse you for the cost of the vaccine.
As noted by Medicare: "Shingles shot - How often is it covered?
The shingles shot isn’t covered by Medicare Part A (Hospital Insurance) or Medicare Part B (Medical Insurance). Generally, Medicare prescription drug plans (Part D) cover all commercially-available vaccines (like the shingles shot) needed to prevent illness. Contact your Medicare drug plan for more information about coverage."
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