Medicare Part B covers the shingles vaccine at no cost to you if you are 50 or older

Medicare Part B pays for the shingles vaccine (Shingrix) with no copay, coinsurance, or deductible once you turn 50. You do not pay anything out of pocket at the time of the shot. The vaccine requires two doses given two to six months apart, and Medicare covers both doses in full.

The catch is that your doctor or pharmacy must be enrolled in Medicare and accept Medicare payment. If you go to an out-of-network provider, you may be charged the full cost upfront and have to file for reimbursement yourself — a process that is slow and not may provide to work. Staying in-network is the simplest path.

You are covered starting the month you turn 50, even if you have not yet reached your birthday. If you are already 50 or older and have not had the vaccine, you can get it now. There is no age limit on the upper end — Medicare covers it at 65, 75, 85, and beyond.

Key Takeaways

  • Medicare Part B covers both doses of Shingrix with zero cost to you if you are 50 or older.
  • Your provider must be enrolled in Medicare and accept Medicare payment, or you will be charged the full price at the time of service.
  • The two doses are given two to six months apart, and both are covered in full.
  • You can get the vaccine at any age 50 and up — there is no upper age limit for coverage.
  • If you received the older shingles vaccine (Zostavax) in the past, you can still get Shingrix; Medicare covers both vaccines for different people.

How to find a provider who accepts Medicare for the vaccine

Call your primary care doctor's office first and ask whether they stock Shingrix and whether they accept Medicare for it. Most primary care practices do. If they do not carry it, ask for a referral to a clinic or pharmacy that does.

You can also call a local pharmacy — CVS, Walgreens, Rite Aid, and most independent pharmacies carry Shingrix and accept Medicare. Call ahead to confirm they have the vaccine in stock, because supply can be uneven. When you call, say you have Medicare Part B and ask them to confirm they will bill Medicare directly so you pay nothing.

Use the Medicare provider search tool at Medicare.gov to find doctors and clinics in your area, though this tool does not always show which ones carry the vaccine. A phone call is faster than searching online.

What happens if your provider is out of network

If you go to a provider who does not accept Medicare, you will be charged the full retail price of Shingrix at the time of service — usually between $150 and $200 per dose. You can then submit a claim to Medicare yourself, but reimbursement is not may provide and can take months.

Some out-of-network providers will give you a receipt and instructions for filing a claim, but others will not. Before you pay, ask the provider whether they will give you the paperwork you need to submit to Medicare. If they cannot or will not, the risk of not being reimbursed is yours.

The simpler approach is to find an in-network provider and avoid this hassle entirely. In-network providers handle the Medicare paperwork, and you walk out owing nothing.

Timing between the two doses

Shingrix is given as two shots. The second dose must be given at least two months after the first dose, but ideally between two and six months. If you wait longer than six months between doses, you do not have to start over — you can still get the second dose and be fully protected.

Medicare covers both doses, so there is no financial reason to delay the second shot. Schedule it at your first appointment so you have a date on the calendar. If you miss the appointment, you can reschedule without losing coverage.

Medicare Advantage plans and the shingles vaccine

If you have a Medicare Advantage plan (Part C), your plan must cover Shingrix with no cost to you, just as Original Medicare does. However, you must use a provider in your plan's network, or you will be charged out-of-network rates.

Call your Medicare Advantage plan directly to find out which doctors and pharmacies in your area carry Shingrix. Your plan's customer service number is on your insurance card. Ask them to confirm the vaccine is covered at no cost and to give you a list of in-network locations that have it in stock.

If you had the older shingles vaccine (Zostavax)

If you received Zostavax — the older shingles vaccine — more than a year ago, you can still get Shingrix. Medicare covers Shingrix even if you had Zostavax in the past. There is no waiting period, though most doctors recommend waiting at least 12 months between the two vaccines.

If you had Zostavax less than a year ago, ask your doctor whether you should wait or go ahead with Shingrix. The timing does not affect Medicare coverage — both are covered — but your doctor may have a preference based on your health.

What to bring to your appointment

Bring your Medicare card. If you have a Medicare Advantage plan, bring that card instead. You will also need a photo ID. That is all you need — no special forms, no prior approval from Medicare, no paperwork to fill out beforehand.

If this is your first visit to that provider, you may be asked to fill out a health history form. Bring a list of any medications you take and any allergies you have. The provider will ask about these before giving the vaccine.

Frequently Asked Questions

Do I have to be enrolled in Part B to get the vaccine covered?

Yes. If you have Original Medicare, you must have Part B active. If you have a Medicare Advantage plan, you automatically have Part B coverage through your plan. If you declined Part B when you first turned 65, you will need to enroll in it before the vaccine is covered.

What if I am 49 and want the vaccine now?

Medicare does not cover Shingrix before age 50. If you want it now, you would pay the full cost out of pocket — usually $150 to $200 per dose. Once you turn 50, Medicare will cover future doses. Some people wait until they turn 50 rather than pay out of pocket.

Can I get the vaccine at a hospital instead of a doctor's office?

Yes, if the hospital has a pharmacy or vaccination clinic. Call the hospital's main number and ask whether they give Shingrix and whether they accept Medicare. Hospital-based clinics usually accept Medicare, but confirm before you go.

Will I have side effects from the vaccine?

This guide provides information about Medicare coverage, not medical information. Talk to your doctor about what to expect. Common side effects are mild — arm soreness, fatigue, or low fever — and usually last a day or two. Your doctor can tell you whether the vaccine is right for you based on your health.

What if I lost my Medicare card?

You can still get the vaccine. Call Medicare at 1-800-MEDICARE to request a replacement card, or go online to Medicare.gov and read a temporary proof of coverage. Show this proof at your appointment along with your photo ID.