Medicare Part B covers Shingrix, the newer shingles vaccine, for adults 50 and older

Yes, Medicare Part B covers Shingrix at no cost to you if you are 50 or older. You do not pay a copay, coinsurance, or deductible for this vaccine when you receive it from an in-network provider. This is one of the preventive services Medicare covers in full.

Shingrix is a two-dose vaccine given two to six months apart. Both doses are covered. The vaccine protects against shingles (herpes zoster) and a painful complication called postherpetic neuralgia, which can last for months or years after the rash clears.

You can receive Shingrix at your doctor's office, a pharmacy, or a health clinic. Make sure the provider is in your Medicare network to avoid unexpected bills. If you have already had shingles, you can still receive Shingrix — there is no waiting period.

Key Takeaways

  • Medicare Part B covers both doses of Shingrix with no out-of-pocket cost for adults 50 and older.
  • You can get Shingrix at your doctor's office, pharmacy, or clinic as long as the provider accepts Medicare.
  • The two doses are given two to six months apart, and both are fully covered.
  • If you have already had shingles, you are still covered for the vaccine.
  • Medicare Advantage plans must cover Shingrix at the same cost as Original Medicare (no cost to you).

Where to get Shingrix under Medicare

You can receive Shingrix at several types of locations. Your primary care doctor can administer it during a regular visit. Many pharmacies, including those inside grocery stores and drugstores, offer Shingrix to Medicare beneficiaries. Federally may have access to health centers and public health departments also provide the vaccine.

Before you go, call ahead to confirm the provider is in your Medicare network. If you have Original Medicare, most providers accept it, but it is worth checking. If you have a Medicare Advantage plan, check your plan's provider directory or call the plan directly to find in-network locations near you.

Bring your Medicare card with you. The provider will verify your coverage before giving you the first dose.

What happens if you have Medicare Advantage

Medicare Advantage plans (Part C) must cover Shingrix with the same cost-sharing as Original Medicare — which means no cost to you. However, some plans may require you to use specific pharmacies or providers to get the vaccine at no charge.

Contact your Medicare Advantage plan before scheduling your vaccine. Ask whether there are preferred locations and whether you need prior authorization. Some plans do not require it; others do. Getting this information ahead of time prevents surprises at the pharmacy or doctor's office.

Timing between the two doses

Shingrix requires two doses. The second dose should be given two to six months after the first dose. If you receive the second dose earlier or later than this window, you do not need to restart the series — the vaccine is still considered complete.

Your provider will schedule the second dose when you receive the first one. Write down the date so you do not forget. If you miss your appointment, contact the provider to reschedule. There is no penalty for a delayed second dose, but getting both doses within the recommended timeframe offers the strongest protection.

If you received the older shingles vaccine (Zostavax)

If you previously received Zostavax, the older shingles vaccine, you can still receive Shingrix. Medicare recommends waiting at least 12 months after Zostavax before getting Shingrix, though you can receive it sooner if needed.

Shingrix is more effective than Zostavax at preventing shingles and postherpetic neuralgia, especially in adults over 65. Because of this, Medicare now covers Shingrix for all adults 50 and older, regardless of whether they received Zostavax in the past.

What to do if a provider bills you incorrectly

Shingrix should never cost you anything out of pocket under Medicare Part B. If a provider bills you a copay, coinsurance, or deductible for the vaccine, that is a billing error.

Contact your provider's billing department first and explain that Shingrix is a covered preventive service with no cost-sharing. Ask for a corrected bill. If the provider does not correct it, contact Medicare at 1-800-MEDICARE (1-800-633-4227) to report the error. You can also file a complaint with your state's insurance commissioner.

Frequently Asked Questions

Do I need a doctor's order to get Shingrix at a pharmacy?

No. Pharmacists can administer Shingrix without a doctor's order in most states. You can walk into a pharmacy and ask for the vaccine. The pharmacist will verify your age and Medicare coverage before administering it.

What if I have had shingles more than once?

You can still receive Shingrix. There is no limit on how many times you can have shingles, and the vaccine can help prevent future episodes. You do not need to wait any specific amount of time after a shingles infection to receive the vaccine.

Will Shingrix cause shingles?

No. Shingrix is an inactivated vaccine, meaning it contains no live virus. It cannot cause shingles. Some people experience mild side effects like arm soreness or low fever, but these are temporary and much less serious than shingles itself.

Can I get Shingrix if I am younger than 50?

Medicare covers Shingrix only for adults 50 and older. If you are under 50 and have a weakened immune system, talk to your doctor about whether Shingrix is right for you. Some insurance plans outside Medicare may cover it for younger adults in specific situations.

What if my Medicare Advantage plan denies coverage?

Contact your plan when ready and ask why. Shingrix coverage is required by law for all Medicare Advantage plans. If your plan continues to deny coverage, file a complaint with Medicare at 1-800-MEDICARE or contact your state's insurance commissioner.