Does Medicare Pay for Shingles Shots?
If you have suffered chickenpox in your early years, you may have concerns about getting shingles after your 50th birthday. And as the risk of getting shingles increases with age, you might be asking, ‘does Medicare pay for shingles shots?’.
There are two answers to this question: yes and no. If you are talking about Original Medicare or Medicare Parts A and B, the answer is a big fat no. Shingles shots are not covered under Original Medicare.
But you can have access to these shots under Medicare Part D or drug plan.
Varicella-zoster virus, which is the culprit behind chickenpox, is the same virus that causes shingles. This virus often re-emerges in later years of human life after remaining dormant for years of decades.
The two most common vaccines for this virus are Shingrix and Zostavax. The good news is that both of these drugs are available under Part D plans.
Drug Plan Coverage
As you might have guessed till now, Medicare Part D is not a single plan for every enrollee. In fact, the enrollees can choose from 40-50 different Part D prescription drug plans (PDPs) depending on their service area.
This difference in coverage plans means that with each plan, you have to pay different out-of-pocket costs for shingles shots. If your plan includes these drugs under Tier 1, you may have to pay lower copayments. If it has included the vaccination shot under Tier 2, the copayment will increase. Your plan may include a deductible which leaves the 100% cost of this vaccine cost on you.
You can consult your plan formulary to know how much coverage you will get.
Does Medicare pay for shingles shot? Yes, if you have enrolled in Part D. If you only have an Original Medicare plan, you will have to pay for the shots from your pocket.
You might also want to read Why Medicare Advantage Plans are Bad