Does Medicare Cover the Shingles Vaccine?
Yes. If you hanve a Medicare Part D plan, it must cover your shingles vaccine. In fact, all Medicare Part D plans must include all commercially available vaccines on their formularies (list of covered drugs), including the shingles vaccine. The formulary can be found on your Part D Plans website, or you can call your plan to request one.
Your Part D plan will pay for the vaccination itself and for your doctor or other health care provider to administer the vaccine. Before you get a vaccination, you should first check coverage rules with your Part D plan to see where you can get your shingles vaccine covered at the lowest cost.
If you receive the vaccination from an in-network pharmacy or from a doctor's office that can bill your Part D plan, you should only need to pay the plan's approved copay at the time you get vaccinated.
If you get the shingles vaccine from a doctor's office that cannot bill your Part D plan, you may need to pay more for it. In this case, you will have to pay the entire cost of the vaccination up front and then follow your Part D plan's rules to get a refund. When you are refunded by the plan, you will only be refunded your Part D plan's approved amount for the vaccination. Keep in mind that you will be responsible for the difference between the doctor's charge and the plan's approved amount.
Remember, the only vaccines that Part D doesn't cover are vaccines that prevent the flu, pneumonia, and hepatitis B. These vaccines are covered under Medicare Part B.
The Sussex County Office of Public Health Nursing offers tips on how to Protect Yourself against the Shingles Virus.