Does Medicare Cover Shingles Vaccines?

Updated on: November 9th, 2020

Reviewed by Diane Omdahl

We aim to help you make informed healthcare decisions. While this post may contain links to lead generation forms, this won’t influence our writing. We follow strict editorial standards to give you the most accurate and unbiased information.

Shingles, also known as herpes zoster, is caused by the same virus that causes chickenpox. If you had chickenpox as a child — as 99% of Americans born before 1980 did1 — the virus can reactivate when you’re an adult and cause painful lesions of the skin. 

One out of three people in the U.S. will develop shingles in their lifetime, and the risk increases as you get older.2 There’s no cure, but there are two FDA-approved vaccines — Zostavax and Shingrix — that can protect you.

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Original Medicare, which is Medicare Part A (hospital insurance) and Part B (medical insurance), doesn’t cover the shingles shot(s), but if you have prescription drug coverage, shingles vaccines are covered. You have two options to get coverage: enroll in Medicare Part D as a stand-alone policy or sign up for a Medicare Advantage (Part C) plan that covers prescription drugs.3 

Why Do You Need the Shingles Vaccine?

In a word: pain. Shingles commonly appears as a rash, usually across one side of your chest, abdomen or face. What starts as itching or tingling becomes an extremely painful band of blisters. These usually scab over in seven to 10 days and clear up in two to four weeks.4

Shingles is most common among people over the age of 50, so the Centers for Disease Control’s (CDC) recommends the vaccine for anyone over that age. 

People with a weak immune system are at even higher risk. Your immunity may be weakened if you:5

  • Are under extreme stress.
  • Have an infection.
  • Have an immune system disease like HIV/AIDS.
  • Have certain cancers.
  • Take immunosuppressive drugs following an organ transplant.

How Does the Virus Spread?

You cannot pass shingles to another person, but you can spread the virus that causes it — varicella zoster virus (VZV) — through direct contact with the fluid that comes from the blisters. The person would then develop chickenpox if they’ve never had it before or never gotten the chickenpox vaccine. 

Shingles must be active, meaning in the blister phase, to be contagious. You cannot transmit the virus before the blisters appear, nor once they crust over.6 Even if the virus is active, the risk of spreading VZV is low if you keep the shingles rash covered.7

What Are the Complications of Shingles?

The most common and lasting complication of shingles is nerve pain, what’s called postherpetic neuralgia (PHN), which can last for months or even years, long after the rash has cleared up. According to the CDC, between 10% and 18% of people who’ve had shingles will develop PHN.

PHN is a stabbing or throbbing pain or weakness where the shingles rash had been. The risk increases with age and the pain lasts longer and is more severe than in younger people.8

In rare cases, shingles can develop into pneumonia, hearing problems, blindness and brain inflammation.9 Only 1% to 4% of people with shingles are hospitalized for complications, though these are typically older adults and people whose immune systems are weak or suppressed, and fewer than 100 people die from shingles each year.10

How Many Times Can You Get Shingles?

You can get shingles more than once. One study reported the odds of getting it again to be nearly 5% within seven years of the first incident. But the good news is that most people who develop shingles only experience one episode in their lifetime.11 

Does Medicare Cover Shingles Vaccines?

Medicare requires that private insurers provide coverage for the shingles vaccines through Part D prescription drug plans. So you’re covered if you’re enrolled in a stand-alone Part D drug plan or a Medicare Advantage plan that has Part D drug coverage.12 

Where Can You Get Shingles Vaccines?

You can get the shingles vaccine at a pharmacy (with a doctor’s prescription) or a doctor’s office. Since Part D plans include pharmacy networks, be sure to get your vaccine at a pharmacy within your plan’s network. The pharmacy can bill your plan directly and you’ll pay only the copay.

How Much Will You Pay for Shingles Vaccines?

You can find both shingles vaccines on your Part D plan formulary or listing of covered medications. Check to see into which tier the vaccine falls; the tier will define how much your insurer will pay and how much you will have to pay.14

If your doctor’s office will provide the vaccination, check to be sure they can bill your plan directly. That way, you’ll have only the copay. Otherwise, you may have to make the full payment upfront and file with your plan for reimbursement. Also, check to be sure that the doctor’s fee for administering the shot is covered as part of your plan’s allowable charge.13

You’ll probably pay the least amount out-of-pocket by being vaccinated at a pharmacy that’s within your drug plan’s network. But if you haven’t met your deductible for the year on your drug plan, you may pay full price for the vaccine. 

If you haven’t had your shingles vaccine yet and you’re selecting a Medicare Advantage plan during the Open Enrollment Period, be sure it’s one of the medications on whatever plan you choose.

What’s the Cost of the Shingles Vaccine?  

According to GlaxoSmithKline, manufacturer of Shingrix, the two-shot series costs people with Medicare Part D an average of $50 per shot.15 

As of May 2020, discount-coupon company GoodRx lists Shingrix at around $151, which is 19% off its reported average retail price of $188.49.16 It indicates that Medicare plans list Shingrix typically in Tier 3 of their formulary. (Tier 3 drugs cost more than Tiers 1 and 2.)17 GoodRx lists Zostavax at prices as low as $218.17.18 

Ultimately, how much your vaccine costs depends on the Medicare prescription plan or Medicare Advantage plan you choose, the vaccine you get and the pharmacy or doctor’s office where you have it administered. 

If the shingles vaccine cost is unaffordable for you, both vaccine manufacturers have Patient Assistance Programs — GSK’s “GSK for You” and Merck’s “Merck Helps” — that may be able to help you with the cost. 

What Happens When You Get the Vaccine? 

As mentioned above, there are two options for the shingles vaccine: Zostavax and Shingrix.

Zostavax has been used in the U.S. since 2006. It’s a single-dose injection given subcutaneously, right beneath the skin’s surface in the upper arm. About 40% of people experience some pain as a result of the shot and it is a live vaccine, which typically isn’t recommended for anyone with a compromised immune system.19 

Studies show Zostavax reduced the risk of developing shingles by nearly 70% in those ages 50 to 59, and by over 50% at age 60 and above. Its effectiveness drops to only 18% for people who are over 80,20 and its protection wanes after about five years.21

Although Shingrix is the newer vaccine (it was approved in 2017), Zostavax is still recommended by the CDC for healthy adults aged 60 and over.22

Shingrix, which contains no live virus, is a two-dose vaccine series given in the muscle of the upper arm. The second shot is given two to six months after the first. In clinical trials, it was effective in nearly 97% of adults in their 50s; over 97% effective for people in their 60s; and over 91% effective for those aged 70 and above. It remains at near 85% effectiveness in all four years following vaccination.23 Because it is more effective, the CDC now recommends Shingrix over Zostavax. 

Shingrix is recommended if you’re age 50 or older and have no severe immune problems. Also, because Zostavax’s effectiveness is lower and wanes, if you’ve already gotten Zostavax, the CDC recommends re-vaccinating with Shingrix.24

Effectiveness does come with a cost: In studies, seven in 10 people experienced pain from the Shingrix vaccine, and nearly half have muscle pain or fatigue and some had headaches, shivering, fever and nausea.25 The CDC suggests avoiding strenuous activities for two to three days after getting either Shingrix shot.

Next Steps

Shingles will affect nearly one out of three people in their lives and the risk climbs as you get older. But you can protect yourself and, perhaps most important, avoid the pain of shingles, with a vaccine.

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  13. Does Medicare Cover the Shingles Vaccine?

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  17. GoodRx. “Humana Co-Pay Prices for Shingrix.” goodrx.com (accessed May 25, 2020).

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  20. What is the difference between Zostavax and Shingrix?

  21. Mayo Foundation for Medical Education and Research. “Shingles.” mayoclinic.org (accessed May 25, 2020).

  22. Centers for Disease Control and Prevention. “Shingles (Herpes Zoster) Vaccination Information for Healthcare Providers.” cdc.gov (accessed May 25, 2020).

  23. Centers for Disease Control and Prevention. “About the Vaccine.” cdc.gov (accessed May 25, 2020).

  24. Recombinant Shingles VIS.”

  25. Esposito, Lisa. “A New Shingles Vaccine: Prepare for Harsher Side Effects.“ U.S. News & World Report, June 15, 2018. (accessed May 25, 2020).