Will Medicare Pay For Shingles Vaccine?

Does Medicare cover shingles vaccine? Will my Medigap plan pay for Shingrix? Can I get the shot for free during my Medicare Annual Exam?

GA Medicare expert Bob Vineyard answers your immunization questions.

Does Medicare Pay for Shingles Vaccine
Will Medicare Pay for Shingles Vaccine?

What is Shingles?

Shingles is a painful, blistering skin rash caused by the varicella-zoster virus. The same virus that causes chicken pox is also responsible for shingles.

After having chicken pox, the virus can lay dormant in your body for years. The virus lives in your nervous system near your spinal cord.

According to Mayo Clinic:

The signs and symptoms of shingles usually affect only a small section of one side of your body. These signs and symptoms may include:

  • Pain, burning, numbness or tingling
  • Sensitivity to touch
  • A red rash that begins a few days after the pain
  • Fluid-filled blisters that break open and crust over
  • Itching
Will Medicare Pay for Shingrix?

What is the Shingles Vaccine and How Does it Work?

Most vaccines start with some form of the virus which is injected. The idea is your body will detect the intruder and generate anti-bodies to attack the virus.

Older vaccines such as Zostavax use a weakened form of the virus. Shingrix, approved in 2017, uses inactivated (dead) virus. Vaccines containing dead virus cells eliminates the risk of transmission.

Is Shingrix Better than Zostavax?

Currently there are only three approved shingles vaccines. Zostavax, Shingrix and Varivax.

Zostavax, approved in 2006, was the only vaccine for shingles for many years.

Shingrix gained approval as a vaccine in 2017 and is considered to be 97% effective in adults age 50 to 69. Whereas Zostavax has a 50% effectiveness rate.

Varivax was approved in 2018. It is similar in price and effectiveness to Shingrix.

All three named shingles vaccines are approved by Medicare and should be included in all Medicare Part D plans.

How Much Does the Vaccine Cost?

Cash prices for Shingrix are currently $150 per dose. You need two doses for maximum effectiveness. Your second does should be given at least 2 months but no more than 6 months following your first dose.

Zostavax is a single dose immunization with a cash price of $225.

The cash price for Varivax is $150 per dose. The manufacturer recommends two doses a month apart.

How Long Before I Need to be Vaccinated Again?

Shingles vaccinations should remain effective for several years before you need another vaccination.

You can get Shingrix at age 50, when your chance of having shingles rises. Studies have shown that its protection remains strong for at least 4 years, but researchers hope it will last much longer because the immune response is stronger. – WebMD

Is the Shingles Vaccine Covered by Medicare?

Medicare covers the shingles vaccine as one of its preventive benefits. But, unlike some other vaccines that are paid through Part B, the shingles vaccine is covered by Part D.

Have You Had Shingles?

If you have chicken pox as a child? If you did you have a one in three chance of getting shingles as an adult.

Two years ago during my annual Medicare wellness visit my doctor asked if I wanted to get the shingles vaccination. We discussed the pro’s and con’s. She wrote a prescription for Shingrix.

I had every intention of getting the shot but all the local pharmacy’s were out of stock. They had no idea when they would have it in stock.

Two months later I woke up with intense itching and moderate pain. It started near my kidney and radiated around my left side.

My wife looked at it and said I had the Shingles.

Welcome to old age.

This was a weekend and my regular doctor was not available. On Sunday I went to a nearby urgent care facility. The doctor confirmed I had shingles.

I was given a prescription for the generic form of Valtrex.

Valacyclovir (Valtrex) is an antiviral medicine. It is used to treat or prevent infections caused by certain kinds of viruses. Examples of these infections include herpes and shingles.This medicine will not cure herpes. It is more popular than comparable drugs. It is available in generic and brand versions. Generic valacyclovir is covered by most Medicare and insurance plans, but some pharmacy coupons or cash prices may be lower. –GoodRx

Using Part D the prescription would have cost nearly $50. Using the coupon and paying cash my cost was $9.

Pay Cash or Use Your Drug Plan?

If you use your Medicare Part D plan for generic drugs you will almost always pay more. Buying generics and paying cash will normally save money.

The approved Shingles vaccines are all brand names. There are no generics. But you may still save money using coupons or drug assistance programs. Check the Medicare site for Patient Assistance Programs.

Do you have Medicare questions? Call or email.

#ShinglesVaccine #Shingrix #GAMedicareExpert

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