Shingles occurs most frequently in people over age 50 and one in three adults in the U.S. will experience shingles. Original Medicare does not help cover the cost of a shingles vaccine, however, you can get coverage for shingles vaccines by purchasing a Part D Prescription Drug Plan (PDP) or enrolling in a Medicare Advantage plan with prescription drug coverage.
What is Shingles?
Shingles is a viral infection caused by the same virus as chickenpox. When a chickenpox infection is over, the virus can live in your nervous system for years before reactivating as shingles.
Shingles usually start as a rash on one side of the face, neck, or body which can then develop into blisters. The initial rash will often be associated with a tingling pain or burning sensation. The blisters form over 3–5 days and eventually dry and crust over. After 2–4 weeks, the scabs will clear up but shingles can also leave scars and permanent pigmentation. Most people get shingles only once but it is possible for it to recur.
What vaccines are available for Shingles?
The Centers for Disease Control and Prevention (CDC) recommends that all healthy adults 50 years and older get vaccinated against shingles. According to the CDC, there are 2 vaccines licensed and recommended to prevent shingles in the U.S.: Shingrix and Zostavax.
The CDC recommends that healthy adults 50 years and older get 2 doses of Shingrix, separated by 2 to 6 months, to prevent shingles and the complications from the disease. Your doctor or pharmacist can give you Shingrix as a shot in your upper arm.
The CDC notes that Shingrix is the preferred vaccine, over Zostavax. This is because Shingrix is 97% more effective in preventing shingles in adults ages 50 to 69, and 91% effective in preventing shingles in adults ages 70 and older.
Does Original Medicare cover the Shingles Vaccine?
Neither Part A nor Part B of Original Medicare covers the shingles vaccines.
However, Medicare Part D does offer coverage on all commercially available vaccines that are needed to prevent illnesses including vaccines for shingles. Most drug plans will cover at least 50% of each drug’s retail price. The average price of the Shingrix vaccine is around $150-$200 per shot (2 doses required) and for Zostavax it’s around $220 – $240 per dose (1 dose required).
Does Medicare Advantage cover the Shingles Vaccine?
Medicare Advantage plans, also known as Medicare Part C, are “all-in-one” packages that include Part A, B, and often include prescription drug coverage as well. You will be able to get coverage for shingles vaccines if you have prescription drug coverage with your Medicare Advantage plan.
In 2020, more than 9 out of 10 beneficiaries (93%) are able to access at least one MA-PD plan with no additional monthly premium.
Does Medigap cover the Shingles Vaccine?
Medigap plans are supplemental insurance plans that help pay for out-of-pocket costs you may incur under Original Medicare and therefore will only cover what Original Medicare covers. This means that Medigap will not cover shingles vaccines as neither Part A nor Part B covers the vaccine.
Part A and Part B of Original Medicare both do not have any coverage for the shingles vaccines. This means if you only have Original Medicare you will be paying 100% for your shingles vaccination costs. Because Original Medicare does not cover shingles vaccines Medigap will also not provide coverage on shingles vaccines. However, Medicare prescription drug plans (Part D) will cover shingles vaccines. You can get prescription drug coverage as a standalone plan or bundle as part of a Medicare Advantage plan.
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