Medicare covers the shingles vaccine, but which one depends on your plan type and age

Medicare Part B covers the Shingrix vaccine (the two-dose shingles vaccine) for people 50 and older at no cost to you — no copay, coinsurance, or deductible. This is true whether you have Original Medicare or Medicare Advantage. However, if you received the older Zostavax vaccine before 2018, you may be able to get Shingrix even if you had Zostavax before, and Medicare will cover it.

The catch is where you get it. Part B covers Shingrix only when you receive it at a doctor's office, hospital outpatient department, or other Medicare-approved provider — not at a pharmacy. If you get Shingrix at a pharmacy (like CVS or Walgreens), it may be covered under your Part D prescription drug plan instead, but you will likely pay a copay. Many people find it simpler to call their doctor's office and ask for the vaccine there.

Shingrix requires two doses given 2 to 6 months apart. Medicare covers both doses in full when given at an approved provider.

Key Takeaways

  • Medicare Part B covers Shingrix (the current shingles vaccine) at no cost for people 50 and older when you get it at a doctor's office or hospital.
  • You do not pay a copay, coinsurance, or deductible for Shingrix through Part B, even if you have not met your deductible.
  • Shingrix requires two doses given 2 to 6 months apart, and both doses are covered.
  • If you get Shingrix at a pharmacy instead of a doctor's office, your Part D plan may cover it, but you will likely pay a copay.
  • You can receive Shingrix even if you had the older Zostavax vaccine years ago.

How to get the vaccine through Medicare Part B

Call your primary care doctor's office or any doctor you see regularly and ask if they have Shingrix in stock or can order it. You do not need a referral. Tell them you want the shingles vaccine and that you are 50 or older — that is all the information they need to know you are covered.

When you arrive for your appointment, bring your Medicare card. The doctor's office will bill Medicare Part B directly. You will not fill out any paperwork related to payment. After your first dose, ask the office staff when to schedule your second dose — it should be 2 to 6 months later, though many offices schedule it 2 to 3 months out for convenience.

If your regular doctor does not offer the vaccine, ask for a referral to a nearby clinic or urgent care that does, or call your local health department — many offer vaccines at low or no cost to Medicare beneficiaries.

What happens if you get Shingrix at a pharmacy

Pharmacies like CVS, Walgreens, and Rite Aid stock Shingrix and can give it to you. When you get it there, the pharmacy bills your Part D prescription drug plan, not Part B. This means you will pay whatever copay your Part D plan charges for vaccines — typically $0 to $50 per dose, depending on your plan.

Some Medicare Advantage plans cover pharmacy vaccines at no cost, while others charge a copay. Check your plan documents or call the customer service number on your insurance card to find out what you will pay before you go to the pharmacy.

If cost is a concern, getting the vaccine at a doctor's office through Part B is the better choice, since Part B covers it completely.

The difference between Shingrix and Zostavax

Zostavax was the older shingles vaccine that Medicare covered for many years. It was a single shot, but it was less effective than Shingrix and is no longer recommended. Medicare stopped covering Zostavax in 2018 and now covers only Shingrix.

If you received Zostavax in the past, you can still get Shingrix. There is no waiting period — you can get Shingrix even if you had Zostavax just a few months ago. Medicare will cover both doses of Shingrix at no cost. Many doctors recommend that anyone who had Zostavax get Shingrix for better protection.

When to get the vaccine and what to expect

You can get Shingrix at any age 50 and older. You do not have to wait until you are a certain age or until you have had shingles. In fact, getting vaccinated before you get shingles is the whole point — the vaccine prevents shingles in about 9 out of 10 people who receive both doses.

The vaccine itself is a shot in the upper arm. Some people feel a sore arm, mild fever, or fatigue for a day or two afterward — this is normal and means your immune system is responding. Serious side effects are rare. You can take over-the-counter pain reliever or fever reducer if you are uncomfortable, but most people have no side effects at all.

Schedule your second dose 2 to 6 months after your first. If you miss the window, you can still get the second dose — there is no time limit, though waiting longer means you have less protection in the meantime.

What to ask your doctor

When you call to schedule your vaccine, ask these questions:

  • Do you have Shingrix in stock, or how long will it take to order?
  • Can I come in for both doses, or do I need to go elsewhere for the second dose?
  • When should I schedule my second dose?
  • Are there any reasons I should not get this vaccine? (Tell your doctor if you are allergic to any vaccine ingredients or if you are currently very ill.)

Frequently Asked Questions

Do I have to get the shingles vaccine?

No, the vaccine is not required. However, the Centers for Disease Control and Prevention recommends it for all adults 50 and older because shingles can be very painful and lead to long-term nerve pain. If you are unsure whether it is right for you, talk with your doctor about your health history.

What if I am on Medicare Advantage instead of Original Medicare?

Medicare Advantage plans must cover Shingrix at no cost when you get it at a doctor's office, just like Original Medicare does. If you get it at a pharmacy, your Part D coverage applies. Check your plan documents or call your plan to confirm your coverage before you schedule.

Can I get Shingrix if I have had shingles before?

Yes. If you have had shingles, you can still get vaccinated. Wait until the shingles rash has healed completely before getting the vaccine. The vaccine can help prevent shingles from coming back, since some people get shingles more than once.

Will Medicare cover Shingrix if I am under 50?

Medicare covers Shingrix only for people 50 and older. If you are under 50 and your doctor recommends the vaccine (for example, if you have a weakened immune system), you would need to pay out of pocket or check whether your other insurance covers it.

What if my doctor says I should not get Shingrix?

Some people should not get Shingrix — for example, if you are allergic to any ingredient in the vaccine or if you are currently very ill with a fever. If your doctor advises against it, ask when you might be able to get it in the future, or ask for a note explaining why so you have it on record.