Medicare covers shingles vaccination, but the amount you pay depends on which part of Medicare you have and which vaccine your doctor gives you

If you have Original Medicare (Part A and B), Medicare Part B covers the shingles vaccine at no cost to you after you meet your Part B deductible. If you have Medicare Advantage (Part C), your plan covers the vaccine, but your out-of-pocket cost varies by plan — some charge nothing, others charge a copay. The two vaccines available are Shingrix (the newer, two-dose vaccine) and Zostavax (the older, one-dose vaccine). Most doctors now give Shingrix because it works better, and Medicare covers both.

The vaccine is covered as a preventive service, which means Medicare treats it the same way it treats flu shots and pneumonia vaccines. You do not need a referral, and you can get it at most pharmacies, clinics, and doctor's offices that accept Medicare. The main thing to know upfront: if you have Original Medicare, you will not pay anything for the vaccine itself once your deductible is met, but you may pay for the office visit if your doctor charges a separate fee.

Key Takeaways

  • Original Medicare Part B covers both Shingrix and Zostavax vaccines with no cost-sharing after your annual deductible is met.
  • Medicare Advantage plans cover shingles vaccination, but your copay or coinsurance depends on your specific plan — call your plan to find out your cost before you go.
  • Shingrix requires two doses given two to six months apart, while Zostavax is a single dose; Medicare covers both, but Shingrix is more effective.
  • You can get the vaccine at pharmacies, clinics, and doctor's offices — you do not need a referral or prior authorization from Medicare.
  • If you are 50 or older and have Medicare, you are old enough to receive the vaccine, though it is most commonly given to people 65 and older.

How Original Medicare Part B covers the shingles vaccine

Under Original Medicare Part B, the shingles vaccine is classified as a preventive service with no cost-sharing. This means Medicare pays its share of the cost, and you pay nothing for the vaccine dose itself. However, you must have met your Part B deductible for the year — in 2024, that deductible is $240, though this amount changes annually. Once you have paid that deductible, the vaccine costs you nothing.

The vaccine is typically given at a pharmacy (like CVS, Walgreens, or Rite Aid) or at your doctor's office. If you get it at a pharmacy, there is usually no separate office visit charge. If you get it at your doctor's office, your doctor may charge a separate office visit fee, which would be your responsibility after your deductible is met. Call ahead to ask whether there is a visit charge — many offices waive it for preventive vaccines, but not all.

Both Shingrix and Zostavax are covered under this benefit. Shingrix is a two-dose series, so you will need to return for a second shot two to six months after the first. Medicare covers both doses the same way — no cost after your deductible.

Medicare Advantage coverage and what you might pay

If you have a Medicare Advantage plan (Part C), your plan is required by law to cover shingles vaccination. However, what you pay out of pocket depends on your specific plan. Some plans cover it with no copay, others charge a copay (usually $0 to $50 per dose), and some use coinsurance (a percentage of the cost). A few plans may require prior authorization, though most do not.

The best way to find out your cost is to call your plan's customer service number, which is on your insurance card. Tell them you want to get the shingles vaccine and ask: What is my copay or coinsurance? Do I need prior authorization? Can I get it at a pharmacy or do I have to go to a doctor's office? Some plans have preferred pharmacies where your cost is lower.

If your plan's cost is high and you are unhappy with it, you can switch to a different Medicare Advantage plan or back to Original Medicare during the annual enrollment period (October 15 to December 7 each year). However, switching plans is a major decision — talk to a counselor at your State Health Insurance information Program (SHIP) before you decide.

Shingrix versus Zostavax: which vaccine Medicare covers

Medicare covers both shingles vaccines, but they are different. Shingrix is the newer vaccine, approved by the FDA in 2017. It requires two doses given two to six months apart. Zostavax is the older vaccine, a single dose. Shingrix is more effective — it prevents shingles in about 90 percent of people who receive it, while Zostavax prevents it in about 50 percent. Shingrix also works better in people over 65, which is why most doctors now recommend it.

If you previously received Zostavax, you can still get Shingrix. There is no minimum waiting period, though most doctors recommend waiting at least 12 months. Medicare covers both doses of Shingrix the same way it covers Zostavax — with no cost-sharing under Part B, or according to your plan's rules under Medicare Advantage.

Your doctor or pharmacist will usually recommend Shingrix because it is more effective. If you have a strong preference for Zostavax or have a medical reason to avoid Shingrix, talk to your doctor — either vaccine is covered.

Where to get the shingles vaccine on Medicare

You can get the shingles vaccine at most pharmacies, clinics, and doctor's offices that accept Medicare. The most common places are chain pharmacies like CVS, Walgreens, and Rite Aid, which often have shorter wait times and no appointment needed. You can also get it at your primary care doctor's office, an urgent care clinic, or a community health center.

You do not need a referral from your doctor to get the vaccine at a pharmacy. You do not need prior authorization from Medicare (though some Medicare Advantage plans may require it — ask your plan). straightforward walk in or call ahead to schedule an appointment. Bring your Medicare card.

If you are not sure where to go, call your doctor's office and ask where they recommend you get it. They may offer it in-house, or they may direct you to a pharmacy. Either way, make sure the place you choose accepts Medicare before you go.

What happens if you have not met your Part B deductible

If you have Original Medicare and have not yet met your $240 annual Part B deductible (as of 2024), you will have to pay the full cost of the vaccine out of pocket until your deductible is met. The cost of Shingrix is typically $150 to $200 per dose at most pharmacies, so the two-dose series could cost $300 to $400 total. Zostavax typically costs $150 to $200 for a single dose.

Once you have paid $240 toward your deductible (through any Part B services — doctor visits, lab work, vaccines, or other covered services), the vaccine becomes free. If you are early in the year and have not met your deductible, you have two choices: pay out of pocket now and have the vaccine covered when ready, or wait until later in the year when you have met your deductible through other medical services.

If cost is a concern, ask the pharmacy or clinic whether they offer a discount for paying cash. Some do, especially if you ask. You can also call your State Health Insurance information Program (SHIP) — they can help you understand your costs and may know of local programs that help pay for vaccines.

Who should get the shingles vaccine and when

Medicare covers the shingles vaccine for anyone 50 or older. However, it is most commonly given to people 65 and older, since shingles becomes more common and more severe with age. If you are 50 to 64 and have Medicare (usually because you have a disability or end-stage renal disease), you are also covered.

You should not get the vaccine if you are allergic to any ingredient in it, or if you have a severe illness at the time you are scheduled to get it. If you have a weakened immune system due to certain medications or conditions, talk to your doctor before getting the vaccine — you may still be able to get it, but your doctor needs to know.

If you have had shingles before, you should still get the vaccine. The vaccine can prevent shingles from coming back, or make it less severe if it does. There is no minimum waiting period after shingles before you can get the vaccine, though most doctors recommend waiting until the rash has healed.

Frequently Asked Questions

Do I have to get both doses of Shingrix, or can I just get one?

You should get both doses for full protection. Shingrix requires two doses given two to six months apart. One dose alone does not provide adequate protection against shingles. Medicare covers both doses the same way, so there is no cost difference between getting one and getting both.

Can I get the shingles vaccine at the same time as other vaccines?

Yes. You can get the shingles vaccine at the same visit as a flu shot, pneumonia vaccine, or other preventive vaccines. You may get them in the same arm or different arms. There is no waiting period between them. Medicare covers all preventive vaccines the same way.

What if I got Zostavax years ago — do I still need Shingrix?

Yes. Shingrix is more effective than Zostavax, and protection from Zostavax fades over time. If you received Zostavax more than a few years ago, your doctor will likely recommend Shingrix. You can get Shingrix even if you previously had Zostavax, with no minimum waiting period, though most doctors suggest waiting at least 12 months.

Will Medicare pay if I get the vaccine out of state?

Yes, as long as the provider accepts Medicare. Medicare coverage is national — it does not matter which state you are in. Just make sure the pharmacy or clinic you choose accepts Medicare before you go. Bring your Medicare card.

What if my Medicare Advantage plan says the vaccine is not covered?

All Medicare Advantage plans are required to cover shingles vaccination. If your plan says it is not covered, call the plan's customer service number and ask to speak with a supervisor. You can also file a complaint with Medicare by calling 1-800-MEDICARE. If the issue is not resolved, you can switch plans during the annual enrollment period.