Medicare Part D provides coverage for the shingles vaccine. People with Part D usually pay nothing out of pocket for most vaccines, including the Shingrix shot for shingles.

Shingles is an infection with the varicella-zoster virus. It can affect anyone who has had chickenpox and causes a range of symptoms, including pain and a skin rash.

In this article, we explore the coverage of the shingles vaccine and explain where people can get it. We also look at the effectiveness and possible side effects of the vaccine, along with the complications of shingles.

a woman getting a shingles vaccine which she does have cover for with medicareShare on Pinterest
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Neither Part A, which is hospital insurance, nor Part B, which is medical insurance, covers the shingles vaccine.

However, Medicare Part D, which is the part of Medicare that deals with medications, provides coverage for the shingles vaccine.

Effective from January 1, 2023, the Inflation Reduction Act (IRA) eliminated cost sharing and deductibles for adult vaccines that the Advisory Committee on Immunization Practices (ACIP)Trusted Source recommend under Part D. This means a Part D plan will not charge a copayment or apply a deductible for vaccines such as Shingrix, which the ACIP recommend.

Glossary of Medicare terms

  • Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
  • Premium: This is the amount of money someone pays each month for Medicare coverage.
  • Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
  • Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
  • Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

Until November 2020, two shingles vaccines were available: Shingrix and Zostavax. However, experts recommended Shingrix over Zostavax because it offered stronger protection. The manufacturer of Zostavax has now discontinuedTrusted Source the production, sale, and use of this drug in the United States.

Many private health insurance plans cover the Shingrix vaccine, but some do not cover the entire cost, according to the Centers for Disease Control and Prevention (CDC)Trusted Source.

Since 2023, people with Part D coverage pay nothing out-of-pocket for the Shingrix vaccine.

It is possible for some people who have neither Medicare Part D nor private insurance to get the shingles shot, and some drug companies even provide it free of charge. People who are unable to afford the shot should ask a doctor about this possibility.

People may get the shingles vaccine at a doctor’s office or, if they have a prescription, at a drugstore.

Who should not get the shingles vaccine?

The vaccine may not be appropriate for people who have a weakened immune system due to certain conditions. These people include those with an organ transplant and those who are undergoing chemotherapy to treat cancer.

Doctors also recommend that people with an allergy to any component of the vaccine do not haveTrusted Source the shingles vaccination.

Anyone with severe allergies must tell a doctor about them when discussing their shingles risk. People who are pregnant or breastfeeding or currently have shingles symptoms should not get the shot.

Complications of shingles

Sometimes, shingles can cause complications. The most commonTrusted Source complication is long-term nerve pain, called postherpetic neuralgia, in the area of the rash. This pain, which can be severe, may decrease within a few weeks or months, but some people might continue to experience it years later.

Some people develop shingles on the face. If the condition affects the eyes, it can occasionally result in temporary or permanent vision loss. If the rash appears within or near the ear, the person is at risk of hearing or balance problems.

Medicare Part D covers the shingles vaccine, but people with these plans may be responsible for a copayment, which can vary depending on the plan and the provider.

Many private health insurers also cover part of the shot’s cost. People with a low income who do not have Medicare or private insurance may be able to get the shingles vaccine at no cost from certain drug companies.

The shingles vaccine is very effective, and the side effects are usually mild. Due to this, doctors advise healthy older adults to get the shot.