Does Medicare Cover the Shingles Vaccine (Shingrix)?

Original Medicare does not cover the shingles vaccine, called Shingrix.

Some Medicare Advantage plans and some Medicare Part D plans, however, may offer coverage for the vaccine. Medicare Advantage plans with prescription drug coverage and Medicare Part D plans typically cover most commercially-available vaccines such as Shingrix.

To find a Medicare Advantage plan or a Medicare Part D prescription drug plan in your area that may cover Shingrix, contact a licensed insurance agent today by calling TTY Users: 711 (24 hours a day, 7 days a week).

Doctor giving a vaccine to patient

What is Shingrix?

Shingrix is the first new shingles vaccine to be developed in more than a decade, and in 2017, it became just the second shingles vaccine to be approved by the Food and Drug Administration.1

The Centers for Disease Control and Prevention (CDC) now recommends Shingrix for people over the age of 50. Shingrix is a double-dose vaccine that is administered with a pair of shots in the upper arm that are generally given within 2-6 months apart.2

Shingrix is set to replace Zostavax as the primary defender against shingles. Zostavax, a live vaccine, became available in 2006 and has shown to provide 70 percent protection against shingles for people between ages 50 and 59, but only 18 percent protection for those 80 and older.

Meanwhile Shingrix, a non-living vaccine, is displaying 97 percent protection for people between ages 50 and 69 and 91 percent protection for those ages 70 and up. Protection against shingles remains above 85 percent for at least four years after receiving Shingrix.

Zostavax, which is also not covered by Original Medicare, is not recommended until the age of 60, while Shingrix can offer protection a full 10 years earlier.  

Shingrix is currently not recommended for people with compromised immune systems or those who are taking moderate to high doses of drugs that suppress the immune system. Shingrix is also not recommended for anyone with a severe allergy to any component of the drug, and anyone who currently has shingles should wait until symptoms resolve before getting the shot.

According to Consumer Reports, the estimated cost of the two Shingrix shots is $280 without insurance. With certain Medicare Advantage plans or Medicare Part D plans, Shingrix may be obtained with just a coinsurance requirement once your plan’s deductible has been met.

What is shingles?

Shingles is a viral infection that causes a painful rash or blisters typically on the torso and back. It is caused by the same virus that causes chickenpox: the varicella-zoster virus.

If you’ve had chickenpox, the virus remains dormant in your body and can reawaken later in life as shingles. In addition to the pain and itching stemming from the rash, shingles can also bring on a fever, fatigue and headaches.

The exact reason for the virus re-emerging as shingles remains unclear, but it’s much more common in older adults and people with a weakened immune system. Shingles is contagious through direct contact with the rash or blisters, but is only contagious to people not immune to chickenpox.

If a person catches the virus from someone else, it will develop as chickenpox and not as shingles.

Find Medicare Advantage coverage for the shingles vaccine

Contact a licensed insurance agent today to find out if a Medicare Advantage plan is available where you live that will cover the shingles vaccine.

Get started by calling TTY Users: 711 to speak to an agent who can answer your questions and help you through the enrollment process.

 

1 Umansky, Diane. The New Shingles Vaccine: What You Should Know About Shingrix. (Jan. 25, 2018). Consumer Reports. Retrieved from www.consumerreports.org/shingles-vaccine/new-shingles-vaccine-shingrix-what-you-should-know.

2 Centers for Disease Control and Prevention. Shingles Vaccination. (Last updated Aug. 22, 2018). Retrieved from www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html.

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