Trevor James
The Shingrix vaccine is used to prevent shingles, a painful skin rash caused by the varicella-zoster virus. The vaccine is FDA-approved and recommended by the CDC for healthy adults aged 50 and older. While original Medicare (Parts A and B) does not cover the cost of the shingles vaccine, Medicare Part D plans, Medicaid, and most private health insurance plans do. For those with Medicare Part D prescription drug coverage, there are typically no out-of-pocket costs for the shingles vaccine. However, coverage and cost can vary depending on the insurance plan and the state, and it's always a good idea to check with your healthcare provider for specific information.
| Characteristics | Values |
|---|---|
| What is Shingrix? | A 2-dose vaccine to prevent shingles (herpes zoster) |
| Who is it for? | Adults 18 years and older who are at an increased risk of shingles due to being immunocompromised by known disease or therapy |
| Who approves it? | FDA-approved and recommended by the CDC |
| Who does Medicare Part D pay for? | All Medicare Part D beneficiaries |
| How much do they pay? | $0 per dose |
| Where can it be administered? | At a pharmacy or doctor's office |
| What is the effectiveness? | More than 90% effective at preventing shingles and postherpetic neuralgia (PHN) in healthy adults 50 and older |
| What are the side effects? | An increased risk of Guillain-Barré syndrome (severe muscle weakness) was observed after vaccination with Shingrix |
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What You'll Learn
Medicare Part D covers the Shingrix vaccine
Medicare Part D typically covers all adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), including Shingrix. This means that if you have Medicare Part D, you usually pay nothing out of pocket for the Shingrix vaccine, as your Part D plan will not charge you a copayment or apply a deductible for ACIP-recommended vaccines. However, it's important to note that coverage and cost may vary depending on your specific plan and location, so checking your plan's Explanation of Benefits (EOB) is essential to confirm coverage.
The availability of Shingrix vaccine coverage under Medicare Part D also depends on the state. Over two-thirds of states and the District of Columbia have expanded their Medicaid programs and are likely to cover Shingrix. In these states, Medicaid typically covers Shingrix for patients 50 years and older. However, in states that have not expanded Medicaid, coverage of Shingrix is less likely.
It is worth noting that the Inflation Reduction Act has removed cost-sharing for ACIP-recommended adult vaccines covered under Medicare Part D starting in 2023. This means that individuals with Medicare Part D will pay $0 for the Shingrix vaccine when administered through their pharmacy. However, most doctors' offices cannot bill for vaccinations for Part D enrollees, so it is essential to confirm billing capabilities before receiving the vaccine.
To summarise, Medicare Part D covers the Shingrix vaccine, providing protection against shingles and its potential long-term complications. Coverage details may vary based on your specific plan and location, and it is always recommended to consult your healthcare provider or insurance carrier for personalised information regarding your coverage and any potential out-of-pocket costs.
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Shingrix is a two-dose vaccine
Medicare Part D covers the shingles vaccine, which means that people with Part D usually pay nothing out of pocket for the shingles shot. This includes the SHINGRIX vaccine, which is a 2-dose vaccine. The second dose is typically administered 2-6 months after the first dose. Completing both doses is the only way to get the full protection offered by SHINGRIX.
SHINGRIX is an FDA-approved vaccine for the prevention of shingles (herpes zoster) in adults 18 years and older who are or will be at increased risk of shingles due to being immunocompromised by known disease or therapy. It is not used to prevent chickenpox. In clinical trials, it was proven to be more than 90% effective in preventing shingles in adults 50 years and older. The CDC recommends 2 doses of Shingrix for immunocompetent adults aged 50 and older, separated by 2-6 months, regardless of whether they report a prior episode of herpes zoster or a previous dose of Zostavax, another shingles vaccine that is no longer available in the United States.
The CDC also recommends 2 doses of Shingrix for adults aged 19 and older who are or will be immunodeficient or immunosuppressed due to disease or therapy. For this group, the second dose can be administered as soon as 1-2 months after the first if completing the series in a shorter period is beneficial.
SHINGRIX is available at pharmacies or doctors' offices. However, most doctors' offices cannot bill for vaccinations for Part D enrollees, so it is important to ask upfront if they are able to bill Part D before receiving the vaccination there. Without insurance coverage, the vaccine can be expensive, costing up to $200 per dose or $400 for the full two-dose vaccination.
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The cost of Shingrix without insurance is up to $400
The cost of the Shingrix vaccine varies depending on your insurance status. People with Medicare Part D plans, Medicaid, and most private health insurance plans do not need to pay anything out of pocket for the shingles shot. This is because the Advisory Committee on Immunization Practices (ACIP) recommends the shingles vaccine, and Part D covers all adult vaccines that the ACIP recommends.
However, for those without insurance, the cost of the Shingrix vaccine can be up to $400 for the complete two-dose regimen, or about $200 per dose. The cost of the vaccine without insurance can vary, with some sources stating the price as $395.80 for the full course or $220.65 per dose.
If you are uninsured, you may still be able to access the vaccine at a reduced cost or for free. GSK offers programs to help patients without insurance cover the cost of their medications, including Shingrix. Additionally, state health departments may provide free or low-cost shingles shots based on income, and federally qualified health centers or nonprofit clinics may also offer reduced-cost vaccinations.
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The CDC recommends Shingrix for adults 50+
The CDC recommends that adults aged 50 and above get the Shingrix vaccine to protect against shingles and postherpetic neuralgia (PHN). Shingles is a painful skin rash caused by the varicella-zoster virus, which can also lead to long-term health complications. In fact, the CDC advises that there is no maximum age for getting the Shingrix vaccine.
Shingrix is an FDA-approved, 2-dose vaccine that is more than 90% effective in preventing shingles in healthy adults aged 50 and older. It is also highly effective in preventing PHN, which is a common complication of shingles that can cause severe pain lasting for months or even years. The second dose of the vaccine is typically administered 2-6 months after the first dose.
The CDC's recommendation for the use of Shingrix in immunocompetent adults aged 50 and above became official CDC policy in January 2018. This recommendation is based on the high efficacy of the vaccine in preventing shingles and related complications in this age group.
Medicare Part D plans cover the Shingrix vaccine, and beneficiaries typically pay nothing out of pocket for the vaccination. This means that people with Medicare Part D will not be charged a copayment or deductible for the Shingrix vaccine.
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Medicaid covers Shingrix in over two-thirds of states
The Shingrix vaccine is covered by Medicare Part D, and patients typically pay nothing out of pocket. Part D covers all adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), including the shingles vaccine.
Medicaid coverage of Shingrix depends on the state. Medicaid covers Shingrix in over two-thirds of states, specifically those that expanded Medicaid under the Affordable Care Act. In these states, Medicaid likely covers Shingrix for patients 50 years and older with little to no cost. The remaining states that have not expanded Medicaid are less likely to cover Shingrix.
The Inflation Reduction Act of 2022 made vaccines more accessible for Medicare and Medicaid recipients. Starting in 2023, Medicaid fully covers vaccines, but only in states that expanded Medicaid coverage. If you have Medicaid and live in a state with expanded Medicaid coverage, you will likely pay little to no cost for Shingrix.
GSK offers programs to help patients without insurance access Shingrix at a lower cost. Contact your healthcare provider to learn more about your expected costs.
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Frequently asked questions
Yes, Medicare Part D covers the Shingrix vaccine.
No, you do not have to pay anything out-of-pocket for the shingles shot if you have Medicare Part D.
Yes, Medicare Part D covers the full cost of the Shingrix vaccine.
You can get the Shingrix vaccine at your pharmacy or doctor's office.
The Shingrix vaccine is a 2-dose vaccination for the prevention of shingles in adults aged 50 and older.
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