One out of every three Americans will develop shingles — a viral infection that causes a painful rash — during their lifetime.
A two-shot vaccine called Shingrix can help prevent shingles, which predominantly affects older people.
Thanks to a recent federal law, the shingles vaccine is now free for people enrolled in a Medicare prescription drug plan.
Even if you’re too young to qualify for Medicare, your current health insurance will likely cover the shingles vaccine at no cost.
Here’s what you need to know.
Does Medicare Cover the Shingles Vaccine?
Starting Jan. 1, 2023, all adult vaccines recommended by the CDC’s Advisory Committee on Immunization Practices are fully covered for people with Medicare drug coverage —- including the shingles vaccine.
You can now receive these shots for free, without a copay, even if you haven’t met your yearly deductible.
The shingles vaccine is fully covered whether you have a standalone Medicare Part D plan or a Medicare Advantage plan with built-in prescription drug benefits.
Medicare prescription drug coverage is voluntary; it isn’t included in Original Medicare (Part A and Part B).
In 2022, an estimated 49 million Medicare beneficiaries were enrolled in Medicare Part D plans, according to the Kaiser Family Foundation. Only about 10% of the 65 million people enrolled in Medicare lacked creditable prescription drug coverage.
The Inflation Reduction Act, signed into law in August 2022, ushered in free shingles vaccine coverage for Medicare beneficiaries. The sweeping legislation also green lit other major changes to Medicare, including capping insulin copays to $35, limiting out-of-pocket beneficiary Part D drug costs to $2,000 a year and giving the federal government the power to negotiate Medicare drug prices with pharmaceutical companies.
The Inflation Reduction Act also eliminated out-of-pocket costs for the Tdap vaccine (tetanus, diphtheria and pertussis, commonly known as whooping cough).
Before this provision took effect, many Medicare beneficiaries paid a copay to receive the Tdap vaccine and the two-dose Shingrix vaccine.
How to Get the Shingles Vaccine
You can get the shingles vaccine at your local pharmacy or at your doctor’s office. Your local health department may have the vaccine too.
In the past, you may have needed a prescription from your doctor to receive a shingles shot at the pharmacy, but most states have phased out this requirement.
Make sure the pharmacy you visit is in your Medicare drug plan network before getting the shingles vaccination. Similarly, if you get the shot at your doctor’s office, confirm that your doctor can bill Medicare Part D before you get vaccinated.
What Is the Shingles Vaccine — and Who Needs It?
Shingrix is the vaccine approved by the Food and Drug Administration in 2017 to help prevent shingles in older adults.
Shingrix is a two-dose vaccine. You’ll get the second dose two to six months after the first shot. The vaccine is more than 90% effective at keeping you from getting shingles and its related complications, which can include long-term nerve pain and brain inflammation.
Your risk of getting shingles increases with age, which is why the Centers for Disease Control and Prevention recommends all adults ages 50 and older get vaccinated.
Shingrix replaced Zostavax in November 2020 as the recommended shingles vaccine in the U.S. Even if you received Zostavax before it was retired — or you’ve had shingles in the past — the CDC still recommends getting inoculated with Shingrix.
Shingles is caused by the same virus that causes chickenpox. If you’ve ever had chickenpox — and 99% of people born before 1995 have — then the virus is already in your body. While the virus usually stays dominant, it reactivates in about one-third of adults, causing shingles.
Do Other Health Insurance Plans Cover the Shingles Vaccine?
Medicare beneficiaries aren’t the only ones who can get the shingles vaccine for free.
All health insurance plans purchased through the Health Insurance Marketplace cover the shingles vaccine with no out-of-pocket costs.
Medicaid coverage for the shingles vaccine varies by state. Medicaid covers Shingrix for people ages 50 and older in about two-thirds of states (specifically, those that expanded Medicaid under the Affordable Care Act).
If you’re enrolled in private insurance, there’s a good chance the shingles vaccine is covered for you as well. Health plans covering 96% of commercially insured members now cover Shingrix, according to the company’s website.
What If I Don’t Have Insurance?
Without insurance, the shingles vaccine retails for about $438 for both doses, or about $219 per shot, according to GoodRx. Presenting a GoodRx coupon at the pharmacy can lower your cost to about $188 per dose.
GSK, the company that manufactures Shingrix, offers a patient assistance program for vaccines for patients without insurance.
To qualify, your gross household income cannot exceed $3,645 a month for a single person or $4,930 a month for a family of two.
You’ll need to apply for the financial assistance program through your doctor. Your health care provider will need to register with the program, then submit the application on your behalf.
Rachel Christian is a Certified Educator in Personal Finance and a senior writer for Codetic. She focuses on retirement, Medicare, investing and life insurance.