Medicare Part C covers shingles shots, but the details depend on which plan you have and which vaccine your doctor gives you

Medicare Part C, also called Medicare Advantage, must cover the same preventive services that Original Medicare covers — and that includes the shingles vaccine (Shingrix). However, your out-of-pocket cost and where you can get the shot depend on your specific plan and whether your doctor's office is in your plan's network.

The shingles vaccine requires two doses given two to six months apart. Most Medicare Advantage plans cover both doses with no copay when you get them from an in-network provider, because the vaccine is classified as a preventive service. If you go out of network or choose a provider your plan doesn't contract with, you may pay more or the full cost.

Key Takeaways

  • All Medicare Advantage plans must cover Shingrix (the shingles vaccine) as a preventive service with no copay when you use in-network providers.
  • You need two doses of Shingrix given two to six months apart to be fully protected against shingles.
  • Check your plan's provider directory or call the member services number on your insurance card to find in-network locations where you can get the vaccine.
  • If you received the older shingles vaccine (Zostavax) in the past, you can still get Shingrix; your doctor can advise on timing.

How Medicare Advantage plans handle preventive vaccines

Medicare Advantage plans are required by federal law to cover all preventive services that Original Medicare covers at no cost to you when you use in-network providers. The shingles vaccine (Shingrix) is on that list because the Centers for Disease Control and Prevention (CDC) recommends it for all adults 50 and older.

The "no cost" part is important: it means no copay, no coinsurance, and no deductible applies to the vaccine itself when you get it from a doctor or pharmacy your plan contracts with. However, if your plan charges a copay for the office visit where you receive the shot, you may owe that copay — the vaccine is free, but the visit might not be.

Some Medicare Advantage plans also cover vaccines at pharmacies like CVS, Walgreens, or your local grocery store pharmacy. Others require you to go to your primary care doctor or a contracted clinic. Your plan documents or member services line will tell you which locations are covered.

Finding in-network providers for your shingles vaccine

The easiest way to find where you can get Shingrix covered is to call the member services number on your Medicare Advantage insurance card. Tell them you want the shingles vaccine and ask which doctors, clinics, or pharmacies in your area have it in stock and are in your network.

You can also check your plan's online provider directory, though not all directories list which vaccines are available at each location. If you already have a primary care doctor in your plan, call their office and ask if they carry Shingrix and whether you need an appointment or can walk in.

Many pharmacies now stock Shingrix and participate in Medicare Advantage networks. If you prefer to get the vaccine at a pharmacy rather than a doctor's office, ask your plan's member services whether your preferred pharmacy is in network. Some plans cover pharmacy vaccines with no copay; others may charge a small copay for the pharmacy visit.

What happens if you go out of network

If you get the shingles vaccine from a provider who is not in your Medicare Advantage plan's network, you will likely pay the full cost out of pocket. The amount varies widely — Shingrix can cost $150 to $300 per dose at retail prices, so two doses could run $300 to $600 total.

Some Medicare Advantage plans offer out-of-network coverage for preventive services, but it is not required. Check your plan's summary of coverage or call member services to ask whether out-of-network preventive vaccines are covered and at what cost.

If cost is a barrier and you cannot find an in-network provider near you, ask your doctor's office to contact your plan and request an exception or out-of-network authorization. Plans sometimes approve out-of-network care when an in-network option is not reasonably available.

The two-dose schedule and timing between shots

Shingrix requires two doses to be fully effective. The second dose should be given two to six months after the first dose. Your doctor or pharmacist will schedule both appointments when you get the first shot, or you can call to schedule the second dose once you know your schedule.

Both doses are covered by Medicare Advantage plans as preventive services, so you should not pay a copay for either one if you use in-network providers. If you miss your second dose window, you can still get it — there is no maximum time between doses, though your doctor may recommend getting it sooner rather than later.

Some people experience mild side effects after Shingrix, such as arm soreness, fatigue, or low-grade fever. These are normal and usually go away within a day or two. Serious side effects are rare.

If you had the older shingles vaccine (Zostavax)

Zostavax, the older shingles vaccine, was given to many people over 60 before Shingrix became available. If you received Zostavax in the past, you can still get Shingrix. The CDC recommends that people who previously received Zostavax get Shingrix at least 12 months later for better protection.

Your doctor can tell you whether enough time has passed and whether Shingrix is right for you now. If you are not sure whether you had Zostavax or when you had it, ask your doctor to check your vaccination records. Your Medicare Advantage plan will cover Shingrix the same way it covers any other preventive vaccine.

Frequently Asked Questions

Do I have to pay a copay for the shingles vaccine under Medicare Advantage?

No copay applies to the vaccine itself when you get it from an in-network provider, because it is a preventive service. You may owe a copay for the office visit if your plan charges one for doctor visits, but the vaccine dose is free.

Can I get the shingles vaccine at my pharmacy instead of my doctor's office?

Many Medicare Advantage plans cover the vaccine at in-network pharmacies like CVS, Walgreens, and others. Call your plan's member services to confirm your pharmacy is in network and whether there is a copay for the pharmacy visit.

What if my plan does not have Shingrix in stock near me?

Call your plan's member services and ask them to help you find a location with the vaccine in stock. If no in-network provider nearby has it, ask whether your plan will cover an out-of-network dose or authorize a provider outside your network.

How long do I have to wait between the first and second dose?

The second dose should be given two to six months after the first. Your doctor or pharmacist will schedule it when you get the first shot, or you can call to book it once you know your schedule.

Is the shingles vaccine covered if I switch Medicare Advantage plans?

Yes. All Medicare Advantage plans must cover Shingrix as a preventive service. If you switch plans, your new plan will cover the vaccine the same way. Make sure to bring your vaccination record to your new plan's providers so they know you have had the first dose.