Does Medicare Cover Shingles?

As we age, our immune system weakens, which can make us more susceptible to various diseases and conditions. One such condition is shingles, a viral infection that causes a painful rash.

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If you’re a senior, you may be wondering whether your Medicare coverage includes shingles treatment and prevention options. In this article, we’ll answer the question, “Does Medicare cover shingles?” and provide you with essential information about Medicare coverage for shingles treatment and prevention.

What are Shingles?

Shingles is a viral infection that is caused by the same virus that causes chickenpox, the varicella-zoster virus. After you recover from chickenpox, the virus remains in your body and can reactivate later in life, causing shingles. Shingles typically cause a painful, itchy rash that appears on one side of the body, often in a stripe-like pattern. Other symptoms may include fever, headache, and fatigue.

Shingles can be particularly painful and uncomfortable, especially for seniors. If left untreated, it can lead to complications such as long-term nerve pain, vision loss, and skin infections. Therefore, it’s important to seek medical attention as soon as you suspect you may have shingles.

Does Medicare Cover the Shingles Treatment?

Medicare coverage for shingles treatment depends on the type of Medicare plan you have. Generally, Medicare Part A and Part B do not cover the treatment of shingles itself, but they do cover some of the complications that may arise from shingles. For example, Medicare Part B may cover the cost of seeing a doctor for the treatment of shingles-related nerve pain.

If you need prescription medication to treat shingles, you may be covered under Medicare Part D. Medicare Part D is an optional benefit that covers prescription drugs. However, not all Part D plans cover all medications, so it’s important to check your plan’s formulary to see if your shingles medication is covered.

Does Medicare Cover the Shingles Vaccine?

Medicare does cover the shingles vaccine, which is an essential preventive measure for seniors. The shingles vaccine can significantly reduce the risk of developing shingles and its complications. There are two types of shingles vaccines available in the United States: Zostavax and Shingrix.

Zostavax, the older of the two vaccines, is a live attenuated vaccine that is given as a single injection. Medicare Part D covers Zostavax, but it may require a copayment or coinsurance. However, Zostavax is no longer recommended as the preferred shingles vaccine by the Centers for Disease Control and Prevention (CDC).

Shingrix is a newer, non-live vaccine that is given in two injections. It is more effective and longer-lasting than Zostavax, making it the preferred shingles vaccine for seniors. Shingrix is covered under Medicare Part D, but like Zostavax, it may require a copayment or coinsurance.

How much is a Shingles shot under Medicare Part D in 2023?

The cost of the shingles vaccine has been reduced as of 2023, with the Inflation Reduction Act eliminating all out-of-pocket costs for vaccines recommended by the CDC’s Advisory Committee on Immunization Practices for adults. This means that even if you have drug coverage from Part D or a Medicare Advantage plan, you will not have to pay any copayment for the shingles vaccine.

If you don’t have prescription drug coverage, you may need to pay over $180 per dose for Shingrix, the FDA-approved vaccine that replaced Zostavax in November 2020. However, it’s recommended that you get vaccinated with Shingrix even if you received Zostavax before it was retired. Adults aged 50 and over should receive two doses of Shingrix, spaced two to six months apart, to be fully protected.

How often Should You Get the Shingles Shot?

If you’re wondering how often you need to get the shingles vaccine, the answer depends on which vaccine you receive. If you receive Zostavax, you only need one dose. However, if you receive Shingrix, you need two doses, given two to six months apart.

Even if you’ve already had the Zostavax vaccine, it’s recommended that you still receive the Shingrix vaccine. The CDC recommends that all adults age 50 and older receive the Shingrix vaccine, regardless of whether they’ve had shingles or the Zostavax vaccine.

The Benefits of the Shingles Vaccine

The shingles vaccine has numerous benefits for seniors, including:

1. Reducing the Risk of Developing Shingles: The most significant benefit of the shingles vaccine is that it can reduce the risk of developing shingles. Shingles can be a painful and debilitating condition, especially for seniors. By getting vaccinated, you can significantly reduce the chances of getting shingles.
2. Preventing Complications: The shingles vaccine can also prevent complications that can arise from shingles, including long-term nerve pain, vision loss, and skin infections.
3. Increased Effectiveness: The newer shingles vaccine, Shingrix, is more effective and longer-lasting than the older vaccine, Zostavax. Studies have shown that Shingrix is 90% effective in preventing shingles in adults over age 50, and the protection can last for up to four years.
4. Improved Quality of Life: By reducing the risk of shingles and its complications, the shingles vaccine can improve the quality of life for seniors. Seniors who get vaccinated may be less likely to experience pain and discomfort associated with shingles, which can impact their daily activities and overall well-being.
5. Cost Savings: Getting vaccinated can also save seniors money in the long run. Treating shingles and its complications can be expensive, especially if hospitalization is required. By preventing shingles, the vaccine can help seniors avoid costly medical bills.

Data has proven that the shingles vaccine is an essential preventive measure for seniors. By reducing the risk of shingles and its complications, the vaccine can improve quality of life, save money, and promote overall health and well-being. If you’re a senior, be sure to check with your healthcare provider and Medicare plan to see if the shingles vaccine is covered and when you should receive it.

Possible side-effects associated with the Shingles Vaccine

Like all vaccines, the Shingrix vaccine can cause some side effects. However, most people who receive the vaccine experience only mild to moderate side effects, which typically resolve within a few days. Here are some of the most common side effects of the Shingrix vaccine:

1. Pain and Swelling at the Injection Site: Many people experience pain, redness, or swelling at the injection site. These symptoms usually go away within a few days.
2. Fatigue: Some people may feel tired or fatigued after receiving the vaccine.
3. Headache: Headaches are a common side effect of the Shingrix vaccine. They are usually mild and go away on their own.
4. Muscle Aches: Some people may experience muscle aches, which can be mild or moderate in intensity.
5. Fever: A low-grade fever is a possible side effect of the Shingrix vaccine, but it is uncommon.
6. Nausea: Nausea and vomiting are rare side effects of the vaccine.

It’s worth noting that the side effects of the Shingrix vaccine tend to be more pronounced after the second dose. However, the vaccine is generally well-tolerated, and serious side effects are rare. If you experience any side effects after receiving the vaccine that persists or worsens over time, be sure to contact your healthcare provider.

Which Medicare Supplement plan will help pay for the Shingles Vaccine?

Although most Medicare Supplement (Medigap) plans will not cover your out-of-pocket expenses for the cost of the Shingles Vaccine, if you are treated for Shingles by a doctor or have to be hospitalized as a result of shingles, your Medigap plan will help pay for the out-of-pocket costs associated with your treatment for Shingles.

For more information about the Shingles Vaccine and to find the best plan that will cover your out-of-pocket expenses for the vaccine or if you come down with shingles, contact the Medicare Solutions Team at 844-528-8688 during normal business hours or contact us through our website at your convenience.

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