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Does Medicare cover the shingles vaccine?

Medicare Part D typically covers the shingles vaccine for free, but original Medicare won't
Lindsay Modglin, contributor to SingleCare
By and | Updated on Dec. 13, 2024 Medically reviewed by Josephine Bawab, Pharm.D. & Scott Dershowitz, LMSW, CMC
Syringe and vial used for vaccinations: Does Medicare cover shingles vaccines?

Key takeaways

  • Medicare Part D covers the shingles vaccine, but Medicare Parts A and B do not.

  • Shingrix is the only shingles vaccine available in the United States as of 2023. It is recommended for adults 50 years and older and adults 19 and older who are immunodeficient or immunosuppressed.

  • Without Medicare prescription drug coverage or insurance, the average price of Shingrix is $286 per dose. Two doses are needed for full protection against shingles.

  • If you don’t have Medicare Part D or a Medicare Advantage plan with drug coverage, you can save on Shingrix by using SingleCare, patient assistance, or Medicare Extra Help. 

In this article:

Shingles (herpes zoster) is a viral infection caused by the varicella-zoster virus (VZV), which is the same virus that causes chickenpox. Anyone who has had chickenpox in the past is at risk of getting shingles, but the virus is most likely to reactivate when the immune system gets weakened by age or emotional or physical stressors. Shingles can cause a painful rash with fluid-filled blisters, typically on one side of the body.

Shingrix is the only available vaccine that prevents shingles. Zostavax, another shingles vaccine, was discontinued in 2020. Shingrix is recommended for adults 50 years and older and adults 19 years and older who are or will be immunodeficient or immunosuppressed. Most insurance plans cover Shingrix, but whether Medicare covers it depends on whether you have prescription drug coverage. 

Does Medicare cover shingles vaccines?

Medicare doesn’t cover all vaccines in the same way. Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) do not cover the shingles vaccine, even though Medicare Part B covers vaccinations for the flu, pneumonia, hepatitis B, and COVID-19.

If you want Medicare to pay for Shingrix, you must be enrolled in either a Medicare Part D drug plan or a Medicare Advantage plan (Part C) that includes Part A, B, and D coverage. Other Medicare supplement plans, like Medigaps, don’t cover shingles vaccines.

RELATED: Does Medicaid cover Shingrix?

How much does the shingles vaccine cost with Medicare?

While coverage and costs are subject to change, Shingrix is free with Medicare Part D. You may have to pay upfront in some instances, though. For example, if you get your shingles vaccine at your healthcare provider’s office and they do not coordinate with or bill Part D plans directly, you may have to request reimbursement from your plan after paying for your vaccine. 

How much does Shingrix cost without Medicare Part D?

With Medicare Part D, Shingrix is available with no out-of-pocket costs. Without Medicare Part D or other insurance, you can expect to pay an average retail price of about $286 for one 0.5 mL vaccine. Since two doses of Shingrix are needed, the total without insurance comes close to $600.

With a SingleCare coupon, you could pay $221 per Shingrix vaccine, amounting to a savings of about $130 for both vaccinations.

Other insurance plans, including private insurance and Medicaid, may cover the shingles vaccine with no out-of-pocket costs. Contact your insurance company for more information and coverage details.

Where to get the Shingrix vaccine

Where you get your Shingrix vaccine with Medicare depends on where you live. 

“All states permit pharmacists to administer vaccines,” says Ryan Majchrzak, Pharm.D., dementia-care certified owner of Assisted Living Locators of Bel Air in Maryland. “However, state laws differ as to the details of which vaccines can be administered by a pharmacist, and to whom.” For example, some states require the vaccine to be administered by a provider in a healthcare provider’s office or hospital, not a pharmacy. If you receive your shingles vaccine at a healthcare provider’s office, it’s important to ensure that they bill your Part D plan directly.

The vaccine locator on the Shingrix website can help you find a pharmacy that administers the shingles vaccine.

RELATED: Getting the Shingrix vaccine—is it worth it?

Do you need a prescription for the shingles vaccine?

Whether a prescription for Shingrix is necessary depends on where you get vaccinated. You won’t need a prescription if you get vaccinated at your healthcare provider’s office.

Some pharmacies that provide vaccines do so under the standing order of a supervising physician. If your pharmacy requires a prescription, you’ll need to contact your healthcare provider first. They may want to see you in the office beforehand, but not always. Sometimes, the healthcare provider may give you the shingles vaccine at your appointment.

How to save on Shingrix without Medicare

If you don’t have Medicare Part D or a Medicare Advantage plan with prescription drug coverage, there are ways to save on Shingrix. One easy way to get instant savings is to use SingleCare. With the SingleCare app or website, you can access Shingrix coupons you can use at local pharmacies and save up to $130 for both Shingrix doses. Medicare beneficiaries cannot use SingleCare and Medicare coverage together, but they can choose to use whichever offers a better deal for them.  

You may also want to consider the patient assistance program offered by GlaxoSmithKline (GSK), the manufacturer of Shingrix. To be eligible, you cannot have third-party coverage for vaccines, and you need to meet specific income requirements. Your healthcare provider can enroll you in the program.  

If you qualify for Medicare Part D but cannot afford the premiums, you may be eligible for financial assistance through a Medicare program called Extra Help. This program helps people with limited income and resources afford their Medicare Part D premiums and other costs. You may qualify for Extra Help automatically if you have Medicaid or if you receive help from a state-run Medicare Savings Program or Social Security payments. You can apply for Extra Help online through the Social Security Administration. 

Learn more about Shingrix

Who should get a shingles vaccine?

Shingrix is FDA approved to prevent shingles in people ages 50 years and older. Shingrix helps protect against the risk of getting shingles and reduces the risk of getting postherpetic neuralgia (PHN), which causes long-term nerve pain after an attack of shingles.

RELATED: How effective is Shingrix?

How many Shingrix doses do you need?

Shingrix is a two-dose vaccination series. The Centers for Disease Control and Prevention recommends getting your second shot two to six months after your first shot. 

How long does Shingrix last?

According to data published by GSK in 2022, Shingrix is effective for up to 10 years in adults ages 50 years and older. You must get the entire series (two shots, two to six months apart) to be fully protected against shingles. Even if you have had the infection, getting vaccinated can still offer benefits because it may help reduce the risk of developing PHN.

Can you take Tylenol before or after shingles vaccines?

Yes, you can take Tylenol (acetaminophen) before or after the shingles vaccine. You should not take aspirin before or after the vaccine because of the increased bleeding risk.

What are the side effects of Shingrix?

The most common side effects of Shingrix include pain and inflammation at the injection site, headache, muscle pain, fatigue, stomach discomfort, fever, and shivering.

Allergic reactions are less common but still possible. Call 911 if you experience signs of an allergic reaction, which include hives, swelling of the face or throat, trouble breathing, rapid heartbeat, dizziness, and weakness.

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