Does Medicare Cover The Shingles Vaccine?
The situation: My doctor says I should get the shingles shot. Does Medicare cover it, and will I have to pay anything?
Quick Answer
Yes, if you have Medicare drug coverage. Medicare says Part D covers the shingles vaccine, and you pay nothing for it if you have Part D, through a stand-alone drug plan or a Medicare Advantage plan with drug coverage. Part B alone doesn't cover it. Pharmacies usually give it, so check that yours works with your plan.
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What Happened
Ruth, 67, has Original Medicare and a Part D drug plan. Her doctor recommends the two-dose shingles vaccine. She gets both doses at a pharmacy in her plan's network, and pays nothing for either, because Part D covers adult vaccines recommended by the CDC's advisory committee with no cost-sharing. Her neighbor, who has Part B but no drug coverage, is told the vaccine isn't covered by Part B and would have to pay for it himself.
Likely Relevant Policies
- Medicare Part D (drug coverage)
- Medicare Advantage with drug coverage
Potential Coverages
Medicare Part D High likelihood
Medicare says Part D covers the shingles vaccine and you pay nothing for it if you have Part D.
Medicare Advantage with drug coverage High likelihood
Medicare Advantage plans that include drug coverage provide the same Part D vaccine benefit.
Medicare Part B Low likelihood
Part B covers certain other vaccines, such as flu shots, but not the shingles vaccine.
Possible Exclusions
- No coverage if you have no Part D or other drug coverage
- A provider outside the plan's network or rules may bill you more
Questions That Determine Coverage
- Do you have Part D, or a Medicare Advantage plan with drug coverage?
- Is the pharmacy or doctor's office in your plan's network?
- Can the provider bill your Part D plan directly?
Recommended Immediate Actions
- Check that you have Part D or a Medicare Advantage plan with drug coverage.
- Call your plan or pharmacy to confirm they can bill the vaccine to your plan.
- Ask your doctor how many doses you need and when.
Documents to Collect
- Your Medicare and drug plan cards
- A record of each dose and its date
Common Claim Process
Most people get the shingles vaccine at a pharmacy, which bills the Part D plan directly, so there's no claim to file. If a doctor's office gives it, ask beforehand whether it can bill your Part D plan, or you may have to pay and seek reimbursement.
Potential Outcomes
- With Part D, the vaccine costs nothing.
- Without drug coverage, you pay the full price.
- If billing goes wrong, ask the plan how to be reimbursed.
Risk Prevention Tips
- Get the vaccine where your drug plan is accepted.
- Keep a record of both doses.
Frequently Asked Questions
Does Medicare Part B cover the shingles vaccine?
No. Medicare says Part D covers the shingles vaccine. Part B covers certain other vaccines, such as flu and pneumonia shots.
Is the shingles vaccine free with Medicare?
With Part D drug coverage, Medicare says you pay nothing for it. Part D covers adult vaccines recommended by the CDC's Advisory Committee on Immunization Practices that Part B doesn't cover.
Where should I get the shingles shot on Medicare?
Usually at a pharmacy that works with your drug plan. Ask first if a doctor's office will give it, so it can bill your plan.
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The factual claims on this page were checked against these sources. Rules and figures change, so check the source itself if you need to confirm the current version.
- Shingles vaccinesMedicare.gov (Centers for Medicare & Medicaid Services)
Educational information, not advice: This page describes how Medicare coverage generally works, not how your plan will decide a specific bill. Check your plan's details with the plan or at Medicare.gov. This is educational, not medical or legal advice.