According to the Centers for Disease Control and Prevention (CDC), shingles affects around one million Americans annually, and adults 60 years and older account for approximately 1 case per 100 each year.
Shingles is a viral infection stemming from the virus that causes chickenpox. It often appears in the form of a deeply painful rash. Individuals who have had chickenpox in the past are susceptible to shingles at any point in their life, and adults over the age of 50 have an increased risk of developing it. By getting a shingles vaccine, you can greatly reduce your risk of developing the virus.
Each year, we receive questions from clients about whether shingles vaccines are covered by their Medicare plan. Some have been advised by a doctor to get vaccinated to decrease the risk of developing the infection, but many do not realize that if they are vaccinated at the doctor’s office, they will be billed for the injection and possibly an administrative fee, which can be quite costly. Neither the injection nor the administrative fee is covered under Parts A or B of Medicare.
There is good news, though! Shingles vaccines are often covered by Medicare Advantage and Prescription Drug plans. They are usually included on the plan’s formulary and can be billed to Medicare by a pharmacy. In many cases, the most cost-effective option for getting a shingles vaccine is to go directly to a pharmacy because the co-pay tends to be low, and there is no administrative fee. Most major pharmacies do not require a prescription to get a shingles vaccine, and the pharmacist can administer it on-site. Appointments are generally not required, but we recommend calling your pharmacy ahead of time to confirm.
Keep in mind that some shingles vaccines consist of one injection, while others are a two-part series. For those with two injections, there is a separate copay required for each injection.
If you are considering getting a shingles vaccine, we recommend you call your insurance company to discuss what is covered by your Medicare plan.
Your well-being is our top priority. Please contact your physician to discuss advice or questions about shingles as it relates to your personal health history.