Part B of Medicare does not cover Shingles shots.
Part D of Medicare
Part D of Medicare usually does cover Shingles Shots and other available vaccines via Prescription Drug Plans or PDPs. But remember, “cover” and “pay for” do not mean the same thing. Cover means the drug plan includes coverage for the vaccine. Pay for doesn’t mean that. “Cover” may mean that the insurance company doesn’t pay anything until after you “pay for” a Deductible and a co-payment.
Zostavax
For years, Zostavax was the injection typically given as a Shingles Shots. It is still available and given as a single shot. However, since 2017 ACIP (Advisory Committee on Immunization Practices) recommends Shingrix as the preferred Shingles vaccine. ACIP is a division within the Centers for Disease Control and Prevention.
I checked my on my personal PDP vaccination coverage. My Part D plan does a good job of paying for my maintenance drugs. But my maintenance drugs are all generics and fall into Tier 1 and Tier 2 of my plan. Vaccination for Shingrix is not in Tier 1 or 2.
Shingrix
Shingrix come in two parts scheduled two to six months apart. The problem with my PDP is that Shingrix is a Tier 4 drug. In my case that means I would have to pay a $400 deductible first, then a $143.09 copayment for each of the two shots. My wife has the same PDP that I do. So, between the two of us, we have two $400 Deductibles and four $143.09 copayments. And that’s only if we get the shots in the same calendar year. If they fall into two different calendar years, we each have two $400 Deductibles to pay in addition to the $143.09 copayments.
That’s a lot of money. On the other hand, I am willing to bet anyone who has had a bad case of Shingles would have been happy to pay for the vaccinations if it would have kept them from getting it.
The point of all of this being if you want coverage for the Shingles Shots, enroll in the right plan. But, if you do enroll in the wrong one, we can fix that each October 15th.
Jake Young
Individual and Family Specialist since 2002
