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Does Medicare Cover the Shingles Vaccine

January 12, 2020 by bob

 

Yes, Medicare does cover the shingles vaccine, but not under Original Medicare Parts A and B. Instead, it is your Medicare Part D plan that is required to provide coverage for the shingles vaccines.

Unlike some common vaccines, like those for the flu, hepatitis B and pneumonia, shingles shots are not covered under Medicare.

Your risk of shingles increases as you get older. Two vaccines are licensed and recommended to prevent shingles in the U.S..  Zoster vaccine live (ZVL, Zostavax) has been in use since 2006. Recombinant zoster vaccine (RZV, Shingrix), has been in use since 2017 and is recommended  as the preferred shingles vaccine.

Available shingles vaccines, is provided only if you are enrolled in a stand-alone Part D drug plan or a Medicare Advantage plan that includes Part D drug coverage.

Medicare requires Part D plans to cover the shingles vaccine, so if you’re enrolled in Part D, you shouldn’t have difficulty obtaining the shot. Most require a copayment, which can vary widely from plan to plan.

And if you haven’t yet met your plan’s deductible for the year, you’ll likely pay the full price. For Shingrix, the newer vaccine, that averages around $190, according to GoodRx, a website and app that tracks prescription prices.

How to get the Shingles Vaccine:

At the pharmacy. You’ll still need a doctor’s prescription, but once that’s been transmitted, you can get the shot at a retail pharmacy.

Most major chains and some independent pharmacies can administer the vaccine. Just make sure to use a store in your drug plan’s network so that it can bill your plan directly and you’ll owe just the copayment

Steps required for Part D vaccine

1 Prescriber prescribes vaccine
2 Pharmacy gets prescription
3 Pharmacy dispenses vaccine; in some cases, pharmacist administers vaccine
4 Pharmacy bills Part D plan Patient pays cost share to pharmacy

 

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