Does Medicare Cover the Shingles Vaccine?
According to the United States Department of Health & Human Services, around 50 percent of shingles cases in this country occur in people over 60, and your risk of getting shingles increases greatly by the time you reach 70.
So, what are shingles? It’s a disease caused by the same virus as chickenpox. If this virus becomes active, it can set off a painful, inflamed skin rash that often produces fluid-filled blisters.
If you had chickenpox when you were young, the virus can remain dormant in nerve cells in your body, throughout your life. While it doesn’t become active again in most people, for others it can reactivate and cause shingles, also known as herpes zoster.
Even though shingles is a common disease, it shouldn’t be taken lightly. Other possible symptoms along with skin rash and blisters are tingling, itching, and/or numbness of the skin; chills, fever, headache, or nausea. Not everyone has the same symptoms or severity, but if you have shingles blisters on your face you should visit your physician. These blisters can promote eye damage and even blindness. And in extreme cases, shingles can cause hearing loss, facial paralysis, or brain inflammation.
Fortunately, there is a vaccine named Shingrix that is effective in preventing shingles. Doctors recommend that adults over age 50 get the two-dose vaccine. It is safe and easy, and you can get yours at your health care provider’s office or at a participating pharmacy. And another plus? Medicare covers this vaccine and others, here’s a look at which ones.
Does Medicare cover vaccines?
The type of vaccine determines which part of Medicare covers it.
Original Medicare Part B (medical insurance) may cover the following vaccines as part of preventive care services:
- Hepatitis B IF you are at medium to high risk for the disease. If you don’t meet the criteria, you may be eligible for coverage through your Medicare Part D benefits if you have a plan.
- Influenza every year
- Pneumococcal – pneumonia
- Vaccines necessary for treatment or injury such as tetanus or rabis
- Vaccines necessary to reduce risk of exposure to an illness or disease such as the COVID-19 vaccine and boosters.
Original Medicare Part B covers 100 percent of the cost for covered vaccines listed because they are included in the preventive care benefit.
Medicare Part D (prescription drug) benefits cover the following vaccines that aren’t covered by Medicare Part B:
- Tdap (tetanus, diphtheria, and pertussis)
- Herpes zoster (shingles)
- MMR measles, mumps, and rubella
Your Medicare Part D plan may also include coverage for vaccines you need when traveling to certain parts of the world. Your health care provider can give you information about which vaccines are necessary.
Your out-of-pocket costs for vaccines covered by Medicare Part D depend on your individual plan. Because Prescription Drug Plans and Medicare Advantage plans that include prescription drug coverage are sold by private insurance companies, each plan has its own coinsurance amounts, copayments, deductibles, and monthly premiums.
Should you get a shingles vaccine?
Doctors recommend that you get vaccinated for shingles if any of the following is true:
- You’ve previously had chickenpox, the chickenpox vaccine, or shingles.
- You’ve previously gotten a shingles vaccine called Zostavax.
- You don’t remember whether you’ve had chickenpox.
You shouldn’t get vaccinated if any of the following are true:
- You currently have shingles.
- You are currently ill or have a fever.
- You’ve had an allergic reaction to a shingles vaccine in the past.
If you have concerns about whether you should get vaccinated for shingles, your health care provider or physician is the best person to ask for advice.